Letters to the Editor

Thank you for the Dr. John G. Loeffler's letter and for giving us the opportunity to write a rejoinder to his remarks which were certainly well taken. Dr. Loeffler's rejection of barium enema and rectal biopsy in a child of 2-3 years of age with chronic constipation and stool in the rectal ampulla appears to be justified. We did not emphasize the rectal examination and presence of stool in the ampulla, since in our experience stool can be found in the ampulla even in a patient with Hirschsprung's disease, especially with a low segment.

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Rectal Biopsy as an Aid in the Diagnosis of Hirschsprung's Disease

PEDIATRICS ◽

10.1542/peds.18.2.176 ◽

1956 ◽

Vol 18 (2) ◽

pp. 176-176

Keyword(s):

Chronic Constipation ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Rectal Wall ◽

Rectal Biopsy ◽

Distal Segment ◽

Large Bowel Obstruction ◽

Atypical Symptoms ◽

Typical History ◽

History Of

The child with a typical history of chronic constipation, and with physical signs of a distended abdomen and an empty rectal ampulla, who is found to have a widely dilated colon with a narrow distal segment by the radiologist, presents no diagnostic problem. However, the diagnosis of Hirschsprung's disease may be very difficult to establish if part of the classical diagnostic criteria are absent or inconclusive. In such cases, the authors have found rectal biopsy to be a useful diagnostic procedure. They cite as indications for biopsy: (1) suspected Hirschsprung's disease in the newborn infant, because the colon does not become dilated and hypertrophied until the intestinal tract has been functioning for several months; (2) symptoms of upper large bowel obstruction developing soon after birth, because barium enema studies of infants whose entire colons are aganglionic reveal no obstruction of the lumen of the large intestine; (3) radiologic evidence of dilatation of the entire distal segment of the colon, because, in patients with a short aganglionic lesion, the obstruction may be so low that the radiologist is unable to demonstrate a narrow segment extending through the rectosigmoid, and (4) atypical symptoms of megacolon, including diarrhea, episodes of intestinal obstruction, or other symptoms of colonic dysfunction. This procedure has been performed by Swenson and his colleagues on 40 patients. Biopsy specimens obtained from 19 patients, subsequently proved to have Hirschsprung's disease by study of the resected rectum and sigmoid, contained no ganglionic cells. In the other 21 patients, biopsy was performed because Hirschsprung's disease was suspected. Ganglionic cells were present in all of these specimens, and the success of subsequent conservative management of these patients confirmed the diagnosis of chronic constipation. Control material was obtained from 10 cadavers with normal colons, and ganglionic cells were found in all of these specimens. The authors emphasize that this technique is only as good as the specimen obtained. An adequate biopsy of rectal wall must be removed. Multiple histologic sections must be carefully examined before the diagnosis of Hirschsprung's disease is confirmed.

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Suction rectal biopsy in the diagnosis of Hirschsprung's disease and chronic constipation

Pediatric Surgery International ◽

10.1007/bf00166866 ◽

1986 ◽

Vol 1 (2) ◽

pp. 84-89 ◽

Cited By ~ 8

Author(s):

Theodore Z. Polley ◽

Arnold G. Coran ◽

Kathleen P. Heidelberger ◽

John R. Wesley

Keyword(s):

Chronic Constipation ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Rectal Biopsy ◽

Suction Rectal Biopsy

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Duhamel Procedure untuk Hirschsprung’s Disease Anak di RS Syaiful Anwar Malang

KELUWIH: Jurnal Kesehatan dan Kedokteran ◽

10.24123/kesdok.v2i2.2532 ◽

2021 ◽

Vol 2 (2) ◽

pp. 91-95

Author(s):

Herry Wibowo

Keyword(s):

Barium Enema ◽

Anterior Resection ◽

Low Anterior Resection ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Rectal Biopsy ◽

Full Thickness ◽

Duhamel Procedure ◽

Pull Through ◽

Age Range

Abstract— The diagnosis of Hirschprung's disease is made with barium enema and rectal biopsy in full thickness. The Duhamel procedure was performed in 8 cases in 2008 for cases of Hirschsprung's disease. Age range of patients 7 months to 11 years. The average body weight when operated on is 7-21 kg. Morbidity and mortality after surgery were not launched. Anorectal myectomy with low anterior resection, the Duhamel-Martin procedure, and the Soave pull-through endorectal procedure are the most acceptable methods for surgical management. Hirschsprung's disease was treated in Syaiful Anwar Hospital Malang in 2008 with the following data: 1 person in January (1 year), 1 person in February (6 years), 1 person in March (7 years), 3 people in April ( 7 months, 4 years and 2 years), 2 people in August 2008 (7 months and 11 years). Enlarged abdomen with bloating, repeated constipation and sometimes aborted. Withdrawal procedures that work with endorectal withdrawal procedures, all show long results Keywords: duhamel technique, hirschsprung's disease, constipation, infant Abstrak— Diagnosis penyakit Hirschprung dibuat dengan barium enema dan full-thickness rectal biopsy. Duhamel procedure telah dilakukan pada 8 kasus pada tahun 2008 untuk kasus Hirschsprung's disease. Rentang usia penderita 7 bulan hingga 11 tahun. Berat badan rata – rata saat dioperasi 7 – 21 kg. Morbiditas dan mortalitas setelah operasi tidak dilaporkan. Anorectal myectomy dengan low anterior resection, Duhamel-Martin procedure, dan Soave endorectal pull-through procedure adalah metode yang paling dapat diterima untuk penatalaksanaan bedah. Didapatkan Kasus penyakit Hirschsprung's yang berobat di Rumah Sakit Syaiful Anwar Malang selama tahun 2008 dengan data sebagai berikut yaitu 1 orang di Januari (1 tahun) , 1 orang di Februari (6 tahun), 1 orang Maret (7 bulan), 3 orang April (7 bulan, 4 tahun dan 2 tahun), 2 orang Agustus 2008 (7 bulan dan 11 tahun). Tiap penderita mengalami riwayat abdominal distention dengan gejala perut kembung berulang, konstipasi dan kadang –kadang disertai mual. Delapan penderita yang menjalani operasi dengan prosedur endorectal pullthrough , semuanya menunjukkan hasil jangka panjang yang memuaskan. Kata kunci: tehnik duhamel, penyakit hirschsprung's , konstipasi, infant

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Diagnosis of Megacolon: The Rectal Examination

PEDIATRICS ◽

10.1542/peds.37.3.535a ◽

1966 ◽

Vol 37 (3) ◽

pp. 535-536

Author(s):

JOHN G. LOEFFLER

Keyword(s):

Newborn Infant ◽

Barium Enema ◽

Chronic Constipation ◽

Digital Rectal Examination ◽

Rectal Biopsy ◽

Functional Constipation ◽

Diagnostic Dilemma ◽

Rectal Examination ◽

Older Child

The following comments pertain to an article in Pediatrics, 36:572, 1965. In their article, "Aganglionic and Functional Megacolon in Children—a Diagnostic Dilemma," Drs. Kottmeier and Clatworthy have done a commendable job in pointing out the pitfalls of diagnosing aganglionic megacolon in the newborn infant. I am afraid, however, that the authors have given the impression that reliance should be made on barium enema and rectal biopsy when distinguishing between aganglionic megacolon and functional constipation in the older child who presents with chronic constipation. In the article no mention was made about the value of a simple digital rectal examination.

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