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 24 November 2017

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News

Diagnosing Hirschsprung's disease

Key features in a patient's history, physical examination, and radiologic evaluation can differentiate between Hirschsprung's disease and idiopathic constipation, find researchers in the March issue of the Journal of Pediatric Surgery.

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Rectal biopsies are performed as a definitive means of diagnosing Hirschsprung's Disease (HD) in children presenting with constipation. However, examining key features in the history, physical examination, and radiographic evaluation may mean unnecessary rectal biopsies could be avoided.

In this study, researchers from Buffalo, New York, performed a retrospective analysis of patients undergoing rectal biopsy between 1995 and 2001.

The team identified 50 patients with HD, and a concurrent cohort of 50 patients with idiopathic constipation (IC).

The team then compared pertinent features in patients with HD with those with IC using Pearson 2 testing.

60% of patients with HD and 15% of patients with IC experienced onset of symptoms in their first week of life.
Journal of Pediatric Surgery

The researchers found that 60% of patients with HD and 15% of patients with IC experienced onset of symptoms in their first week of life.

In addition, HD patients more frequently experienced delayed passage of meconium, abdominal distension, vomiting, and transition zone on contrast enema. The team determined that all patients with HD had 1 or more of these significant features.

However, only 64% of patients with IC had 1 or more of these features.

The classic triad of symptoms (delayed passage of meconium, vomiting, and abdominal distension) was present in 18%, and 1 or more of these symptoms was present in 98% of HD patients.

In contrast, only 60% of patients with IC had a history of delayed passage of meconium, vomiting, or abdominal distension.

Dr Nicola Lewis's team concluded, "A history of delayed passage of meconium, abdominal distension, vomiting or the results of a contrast enema identified all patients with HD and excluded HD in approximately 36% of patients with idiopathic constipation".

"Key features in a patient's history, physical examination, and radiologic evaluation can differentiate between HD and IC."

"In a child presenting with constipation and none of the above features, it is not necessary to perform a rectal biopsy to exclude HD."

J Pediatr Surg 38(3): 412-16
18 March 2003

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