Case Report: Presentation of a Newborn with Pseudo-Hirschsprung Symptoms at Bahrami Hospital neonatology

A female newborn with GA: ۳۸w+۵d, presented with repeated vomiting and abdominal distention three days after birth, along with jaundice and no passage of meconium. Due to these symptoms, the infant was admitted to the NICU at Bahrami Hospital under suspicion of intestinal obstruction. On the first day of hospitalization, she had not passed meconium. She had no history of fever or seizures. Hearing and vision appeared normal. The baby had a bloated abdomen and mild respiratory distress. Physical examination revealed abdominal distention with prominent intestinal loops, visible bowel peristalsis, and increased bowel sounds. Digital rectal exam revealed an empty rectum with explosive gas and stool release afterward. The baby received a diagnosis of probable Hirschsprung disease and was prepared for a contrast enema. The mother had no history of thyroid disease. Lab results (CBC, calcium, magnesium, phosphorus, BUN, creatinine, CRP) were normal. Thyroid tests revealed TSH = ۷ and Free T۴ = ۱.۶, which were initially interpreted as normal, and no treatment was started. However, due to the persistence of symptoms and no further meconium passage, further investigations and imaging studies were performed to rule out other causes of obstruction. On the ۶th day, a repeat thyroid test showed abnormal results (TSH= ۳۷.۵, Free T۴ ۱.۳۷), confirming congenital hypothyroidism. Treatment with levothyroxine was started, and the patient's symptoms and meconium passage improved over the following days. The baby tolerated feeds and was eventually discharged in good condition. Conclusion: Pseudo-Hirschsprung symptoms in a newborn, despite normal initial thyroid tests, can be an early sign of congenital hypothyroidism. Checking thyroid function tests in newborns presenting with pseudo-obstruction symptoms is important, and early treatment can resolve the patient's symptoms

کلیدواژه ها:

Lack of meconium passage ، pseudo-Hirschsprung ، hypothyroidism