Delayed expenditure meconium in newborn infants (> 48 hours), and found symptoms of intestinal obstruction after day 2 (abdominal distension, vomiting, reduced drinking)
In children: constipation with abdominal distension, growth failure, vomiting, and intermittent diarrhea. Constipation happens frequently followed by explosive diarrhea. It can also be obtained enterocolitis. (Fardah, 2006)
HOW TO EXAMINATION / DIAGNOSIS
1. Rectal examination: anal canal and ampulla small rekti
2. Radiological examination:
a. Plain abdominal |: Bowel distension of experience, a little air in the rectum
b. Colon examination in the loop: There was a transition zone
3. Rectal biopsy
Hirschsprung disease is usually suspected based on symptoms and physical examination. During the physical examination, the doctor will check your child's abdomen for bloating and excessive stool in the colon and rectum. If Hirschsprung's disease is suspected, the following tests can be performed:
Rectal biopsy. This is the most useful test to diagnose Hirschsprung's disease. For this test, a small piece of rectal tissue is removed and examined under a microscope for the presence of nerve cells. If nerve cells are not present, Hirschsprung's disease was diagnosed.
Barium enema. In this test, a whitish liquid (barium) is inserted through the rectum into the intestine. The barium coats the intestine to make it visible on X-rays. If Hirschsprung's disease is present, X-ray will show the swelling of the intestine followed by the narrowed area. But barium enema may not reveal signs of Hirschsprung's disease if the child is younger than age 3 months or if only a small portion of the intestine is affected. A barium enema is not done if doctors suspect that the colon had been swollen for times normal size (toxic megacolon). X-ray abdomen. This test illustrates the structures and organs in the abdomen, including bowel.
Anorectal manometry. In this test, a small tube inserted into the rectum to measure how well the muscles in the anus work. If the muscle does not relax, may indicate Hirschsprung's disease. In newborns (younger than 1 month) and babies born early, this test may not accurate.2 Also, false-positive test result can occur if the colon withdrawn for other reasons, or if the child can not or will not cooperate with testing . A delay in the diagnosis of Hirschsprung's disease can cause children to develop serious, life-threatening complications. (Sexton, 2010)
DIAGNOSIS APPEAL
Idiopathic Constipation
Complications
Enterocolitis
MANAGEMENT
1. General Handling
Stabilizing patients, including fluid and electrolyte balance, antibiotic in case of enterocolitis, as well as evacuation of the colon with an enema
2. Special Handling
Surgery: a colostomy performed, and then proceed with definitive surgery.
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