Findings: There is short segmental narrowing of the rectosigmoid junction with proximal sigmoid dilatation.

The lateral
aspect of the distal sigmoid colon demonstrates a saw-tooth appearance. Final exam imaging demonstrates the cecum
in the mid-upper abdomen. UGI series performed later, images not shown, demonstrated a normal position of the
duodenojejunal junction.

Differential Diagnosis for failure to pass meconium:

Hirschsprung's
Anal atresia
Meconium plug (small left colon)
Meconium ileus (micro colon)

Ileal atresia
Diagnosis: Biopsy proven, Hirschsprungs disease with high-riding cecum.

Hirschsprungs disease - key points:

Absence of ganglion cells cause colonic spasms and therefore a functional obstruction.
The affected colon involves the rectum and a variable amount of the more proximal colon. No skip lesions.
Patients can present later in life with chronic constipation.
More common in males and associated with Down's 5% of the time.
On a normal barium enema, the rectum should be the largest portion of colon and the rectosigmoid caliber ratio
should be greater than 1.
Saw-tooth pattern and fasciculations are sometimes seen within the denervated segment.
Rarely, Toxic Megacolon can be a complication of Hirschsprung's. In this clinical setting, contrast enemas
should be avoided.

References:

1. Donnelly LF. Fundamentals of Pediatric Radiology. Saunders: Philadelphia, PA. 107- 108.
2. http://en.wikipedia.org/wiki/Toxic_megacolon, Accessed on May 5, 2007.
3. http://radiology.rsnajnls.org/cgi/content/full/215/2/391, Accessed on May 5, 2007.