Differential Diagnosis

The differential diagnosis for colonic dilatation includes mechanical obstruction such as carcinoma. All other causes of anorectal stenosis must be excluded. In endemic regions it is sometimes difficult to differentiate between Hirschsprung's disease and Chagasic mega-colon; therefore, in young patients, both conditions should be considered. The concomitant

Figure 25.7. Barium enema showing a chronic intrarectal fecaloma.

presence of megaesophagus or heart disease can help in clinical evaluation. Ultimately, rectal biopsy and physiologic studies of the anus, rectum, and sigmoid are needed.

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