Hirschsprung's disease is a blockage of the large intestine due to improper muscle movement in the bowel. It is a congenital condition, which means it is present from birth.
Alternative Names: Congenital megacolon
Causes, incidence, and risk factors:
Muscle contractions in the gut help digested materials move through the intestine. This is called peristalsis. Nerves in between the muscle layers trigger the contractions.
In Hirschsprung's disease, the nerves are missing from a short or long part of the bowel. Areas without such nerves can not push material through. This causes a blockage. Intestinal contents build up behind the blockage, causing the bowel and abdomen to become swollen. If the condition is severe, the newborn may fail to pass meconium or stool, and the newborn may vomit.
Milder cases may not be diagnosed until a later age. In older children, the disease may be cause chronic constipation, abdominal swelling, and decreased growth.
Hirschsprung's disease causes about 25% of all newborn intestinal obstruction. It occurs five times more frequently in males than in females. Hirschsprung's disease is sometimes associated with other inherited or congenital conditions such as Down syndrome .
Symptoms:
Constipation
Failure to pass meconium shortly after birth
Failure to pass a first stool within 24 - 48 hours after birth
Malabsorption
Poor weight gain
Slow growth (child 0-5 years)
Swollen belly
Vomiting
Watery diarrhea (in the newborn)
Signs and tests:
During a physical examination, the doctor may be able to feel loops of bowel in the swollen belly. A rectal examination may reveal a loss of muscle tone in the rectal muscles.
Tests used to help diagnose Hirschsprung's disease may include:
Abdominal x-ray
Anal manometry (a balloon is inflated in the rectum to measure pressure in the area)
Barium enema
Rectal biopsy
Treatment:
The abnormal section of colon must be surgically removed. Sometimes this can be done in one operation. However, it is frequently done in two parts with a colostomy being performed first, and another procedure being performed later in the first year of life.
Support Groups:
Expectations (prognosis):
Symptoms improve or are eliminated in most children after surgical treatment. A better outcome is associated with early treatment and shorter bowel segment involvement.
Complications:
Inflammation and infection of the intestines (enterocolitis)
Perforation of the intestine
Short bowel syndrome, a condition that can lead to malnourishment and dehydration
Calling your health care provider:
Call your child's health care provider if symptoms of Hirschsprung's disease develop.
Call your child's health care provider if your child has abdominal pain or other new symptoms after being treated for this condition.
Prevention:
Review Date: 10/8/2007 Reviewed By: Deirdre O'Reilly, MD, MPH, Neonatologist, Division of Newborn Medicine, Children's Hospital Boston and Instructor in Pediatrics, Harvard Medical School, Boston, Massachusetts. Review Provided by VeriMed Healthcare Network.
