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Diagnosis of Hirschsprung’s Disease: an age‐related approach in children below or above one year
Author(s) -
Noviello C.,
Cobellis G.,
Romano M.,
Amici G.,
Martino A.
Publication year - 2010
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2009.01940.x
Subject(s) - medicine , anorectal manometry , constipation , hirschsprung's disease , enema , anal sphincter , hypertonia , chronic constipation , group b , internal anal sphincter , gastroenterology , megacolon , surgery , anal canal , disease , rectum , anesthesia
Aim The aim of this study was to evaluate the effectiveness of a differential diagnostic approach to Hirshchsprung’s Disease (HD) on the basis of age. Method Data on 185 consecutive children with suspected HD were subjected to an age‐related diagnostic approach. The patients were divided into two groups according to age (A < 1 year; B > 1 year). Children in Group A had rectal suction biopsy (RSB) and contrast enema (CE), and in Group B anorectal manometry (ARM) was performed. Patients with a normal recto‐anal inhibitory reflex (RAIR) underwent bowel disimpaction and medical treatment. Only selected cases in Group B underwent RSB and CE. Results In Group A (18 patients) CE showed a colonic transitional zone in three patients, whereas RSB led to the diagnosis of HD in nine. In Group B (167 patients) ARM was not possible in seven patients and it was normal in 140 (normal anal sphincter pressure: 83; hypertonia of the internal anal sphincter: 57). The RAIR was negative in 20 patients. RSB performed in 31 children in Group B confirmed HD in three patients. Conclusions For patients with a neonatal onset of constipation RSB is the best diagnostic technique. Chronic constipation is rarely due to HD and ARM is a useful non‐invasive screening tool.