We're discussing a case of hirschsprung diseases in a 6mo old infant. James was preparing for his pull through surgery and had to undergo rectal washouts twice daily at home. Family hopes for a one-step pull through without ostomy but understands the bowel needs tobe decompressed. He's now eating well surgery pull through performed, distal rectosigmoid biopsy sent for frozen-negative ganglion cells, proximal sigmoid biopsy sent for frozen + for ganglion cells, coloanal anastomosis 5cm proximal from biopsy withg anglion cells, dilated to 14 Fr do not give away the dx immediately, the cover title should say like "vomitting and costipation", Follow the rubric almost exactly HISTORY PHYSICAL EXAM DIFFERENTIAL DIAGNOSIS FINAL DIAGNOSIS OPERATIVE FINDINGS LABS COURSE OF DISEASE / CURENT CONDITIONS RELEVANT IMAGES SALIENT POINTS RELEVANCE TO CASE OVERALL MESSAGE OR TAKE AWAY