Rectal biopsy in the investigation of constipation

Abstract

Aims-To develop criteria to prevent unnecessary rectal biopsies in constipated children. Methods-A retrospective review of 186 rectal biopsies from 141 children, comparing the age at onset of symptoms with the diagnosis of Hirschsprung's disease. Results-All of the 17 children with Hirschsprung's disease had the onset of symptoms before the age of 4 weeks. Twenty seven children had delayed passage of meconium (more than 48 hours) of whom 10 had Hirschsprung's disease. Three children with Hirschsprung's disease were referred after the neonatal period (2 months, 11 months, and 3 years) but all had the onset of symptoms before 4 weeks of age. Conclusion-If the age at onset of constipation is after the neonatal period, a rectal biopsy is unnecessary. (Arch Dis Child 1998;79:266-268)

Symptomatology, pathophysiology, diagnostic work-up, and treatment of Hirschsprung disease in infancy and childhood

“…When the baby is clinically stable a colostomy will be performed. For many years, the vast majority of cases of HD have been diagnosed in the neonatal period [56]. Laparotomy is generally performed between 6 and 12 months of age.…”

Management of constipation in children with disabilities

“…more than 24 hours after birth), which might suggest Hirschsprung disease, should prompt a referral for a rectal biopsy. 1 Details of stool consistency and evidence of distress associated with defaecation are helpful pointers to management. Soiling, secondary to obstipation, and an enlarged rectum, should be differentiated from encopresis that can occur without constipation as the treatment differs considerably.…”

“…1 Constipation is particularly common in children with disabilities; in a recent epidemiological survey of nutritional and gastrointestinal problems in children with cerebral palsy, constipation (defined as opening of the bowels less frequently than once in every 3 days) was reported in 98 of 377 (26%) of children. 2 There is frequently a delay in the recognition and appropriate treatment of constipation in children and symptoms are often present for months or years before appropriate treatment is provided.…”

Hirschsprung’s disease: Is there a relationship between mast cells and nerve fibers?

“…Thirty two cases of chronic constipation (defined as decreased frequency of bowel movements "fewer than three each week" or a difficulty in defecation perceived by the parents as a problem that requires medication or manual intervention [1] ) in the age group of 0-14 years were enrolled for the study. Cases of constipation due to local causes like anal fissure, anal stenosis and anterior perineal anus were excluded from the study.…”

“…Constipation is a common presenting complaint in children attending the pediatric outpatient department [1] . Some 13%-15% cases of constipation are due to aganglionosis of bowel segment or Hirschsprung's disease (HD).…”