Abstract
Background: Hirschprung’s Disease in Neonates (HD) is an important cause of intestinal obstruction. To evaluate incidence / clinical investigational profile / treatment modality in HD in neonates, the following study was done.
Method: The neonates who came to pediatric gastroenterology OPD of PGI MER, Chandigarh with clinical feature of HD (e.g. delayed passage of meconium at birth, abdominal distension, vomiting, enterocolitis with fever diarrhea etc.) were admitted from July 1993 to June 2003. History, clinical feature, investigation (USG whole abdomen, barium enema, rectal suction biopsy, CBC, electrolyte etc.) were noted. Surgery (i.e. colostomy followed by definitive surgery of abdominal pull through etc.), and nutritional care like parenteral nutrition etc was done.
Results: Out of 50 neonates of HD, male was 30, female was 20. Age of presentation was 5 – 15 days. Birth weight was 2.5 to 3.5 kg. (average 2.8 kg.).
Delayed passage of meconium was in 45 (90%) cases, abdominal distension in 35 (75%), bilious vomiting in 40 (80%), fever in 5 (10%), diarrhea in 3 (6%), perforation in 5 (10%) cases.
Site of aganglionic segment seen in rectum is 10 (20%), sigmoid colon in 30 (60%), descending colon in 5 (10%), splenic flexure in 3 (6%), 1 (2%) in ileum, total againglionic colon in 1 (2%) cases. Forty (80%) cases had initial colostomy followed by definitive surgery (Boley’s endorectal pull through). In 10 (20%) cases, definitive surgery was done in single phase.
Conclusion: HD is an important cause of neonatal intestinal obstruction. Early detection / management is very important.
References
- Hirshprung’s disease Children Hospital – St. Louis Health Care.
- Langer JC et al Hirshprung’s disease, Ascheraft”s pediatric surgery, 6th edition New York, Elsevier Saunders 2014, P 454 – 98.
- Hirshprung’s disease in New born J Neonatal surgery 2013, Oct – Dec 2 (4) : 51.
- O’ Donovan AN et al Diagnosis of Hirshprung’s disease, Am J. Roentgenol 1996, 167 : 517 – 20 [Pub Med] Google Scholar.
- Smith GH et al Infantile Hirshprung’s disease – is barium enema useful Pediatr surgery Int 1991 6 : 318 – 21. Google scholar.
- Devos As et al, Radiological imaging of digestive tract in infants and children, Springer Verlag, Berlin 2007, Google Scholar.
- Santora GA et al, Benign anorectal disease, diagnosis with endoanal and endorectal ultrasound and new treatment options. Springer Verlag Italy 2006. Google Scholar.
- Kumer P et al, Congenital malformation, evidence based evaluation and management. Mc Graw – Hill USA – 2007. Google scholar.
- NHS (link / conditions / complained).
- NHS (link / conditions / stomach-ache).
- NHS (link / conditions / rectal exam).
- NHS (link / conditions / x-ray).
- NHS (link / conditions / biopsy).
- NHS (link / conditions / down syndrome).
- Frykman PK et al Hirshprung associated enterocolitis – prevention and therapy Semin Pediatr. Surg. 2012 21 (4), 325 – 335.
- H. Teitelbanum et al, Hirshprung’s disease – identification of risk factors of entero colitis.
- NHS (link / conditions / colonoscopy).
- NHS (link / conditions / peritonitis).
- NHS (link / conditions / Laxatives).
- NHS (link / conditions / bowel incontinence).
- NHS (link / conditions / soiling child – pooing – their parts).
- Lukong CS et al, Colonoscopy in neonates under local anaesthesia : Incidence, technology and outcome, Afr J. Pediatr. Surg. 2012, May – August 9 (2)176 – 80
- Children’s Minnesota, Patient and family material.
- Hirshprung’s disease. http//staging-surgery.vcsf-edition.
Corresponding Author
Sujay Chaudhuri
Division of Pediatric Gastroenterology, Department of Gastroenterology, PGIMER Chandigarh
DOI: https://dx.doi.org/10.18535/jmscr/v7i12.13
