Paediatric surgery: contrast enema in Hirschsprung disease: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Surgery · Paediatric surgery: contrast enema in Hirschsprung disease

Sample item

A contrast enema in a constipated neonate shows a narrow rectum with a conical transition to a dilated sigmoid colon, and contrast is still retained on a film at 24 hours. What does the narrow segment represent?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Aganglionic bowel that cannot relax

In Hirschsprung disease the aganglionic segment is tonically contracted and appears narrow, with proximal dilated normally innervated bowel and a transition zone between them. Retained contrast at 24 hours supports it. The diagnosis is confirmed by rectal biopsy.

Option by option

  • A. Extrinsic compression by a presacral mass

    A presacral mass would show a smooth extrinsic indentation, with no conical transition and retained contrast.

  • B. Normal bowel in transient spasm

    Transient spasm would not persist with a fixed transition zone and delayed evacuation.

  • C. An ischaemic stricture

    An ischaemic stricture is seen after necrotising enterocolitis, not in a term neonate with a conical transition.

  • D. Aganglionic bowel that cannot relax (correct)

    Correct. The narrow segment lacks ganglion cells and cannot relax, with dilated bowel above it.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Aganglionic bowel that cannot relax. In Hirschsprung disease the aganglionic segment is tonically contracted and appears narrow, with proximal dilated normally innervated bowel and a transition zone between them.

Why is "Extrinsic compression by a presacral mass" not the answer?

A presacral mass would show a smooth extrinsic indentation, with no conical transition and retained contrast.

Why is "Normal bowel in transient spasm" not the answer?

Transient spasm would not persist with a fixed transition zone and delayed evacuation.

Why is "An ischaemic stricture" not the answer?

An ischaemic stricture is seen after necrotising enterocolitis, not in a term neonate with a conical transition.

What concept does this question test?

It tests Paediatric surgery: contrast enema in Hirschsprung disease in General Surgery. Retained contrast at 24 hours supports it. The diagnosis is confirmed by rectal biopsy.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric surgery: contrast enema in Hirschsprung disease?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.