Aims-To develop criteria to prevent unnecessary rectal biopsies in constipated children. Methods-A retrospective review of 186 rectal biopsies from 141 children, comparing the age at onset of symptoms with the diagnosis of Hirschsprung's disease. Results-All of the 17 children with Hirschsprung's disease had the onset of symptoms before the age of 4 weeks. Twenty seven children had delayed passage of meconium (more than 48 hours) of whom 10 had Hirschsprung's disease. Three children with Hirschsprung's disease were referred after the neonatal period (2 months, 11 months, and 3 years) but all had the onset of symptoms before 4 weeks of age. Conclusion-If the age at onset of constipation is after the neonatal period, a rectal biopsy is unnecessary. (Arch Dis Child 1998;79:266-268)

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In this type of patient, all precautions should be taken to minimize the risk of thrombus formation, including considering the prophylactic use of anticoagulants.

As the incidence of obesity increases, laparoscopic Roux-en-Y gastric bypass (REYGB) surgery has become a surgical option for many patients. Although the laparoscopic Roux-en Y procedure has been shown to reduce weight and improve diabetes, hyperlipidemia, hypertension and sleep apnea, it is not without significant risks, as more than 10% of patients who undergo this procedure have postoperative GI complications. This is a case of a 51 year old man who presented with diffuse abdominal pain one month status-post Roux-en-Y gastric bypass. CT imaging proved to be crucial in the diagnosis of this pathology with small bowel volvulus and ischemia. We review some key CT findings that can aid clinicians in diagnosing internal hernias since this complication is often misdiagnosed and have a mortality rate of more than 50%.