Irregular bowel movements and constipation are a common complaint pediatric complaint.
The majority of cases are functional, but providers should take extra care to rule out organic causes like Hirschsprung's disease particularly during the neonatal period.
1 in 5000 incidence, with abnormal innervation of the distal colon resulting in tonic contraction, and obstruction of feces.
In most cases, the agangionic segment is limited to the rectosigmoid area.
Symptoms usually begin in the first month of life and consist of obstuctive complications such as abdominal distension, bilious vomiting, and poor feeding.
Rectal examination should be done in all patients with constipation, and often reveals a narrowed high-pressure region adjacent to the anal sphincter.
Barium enema, anal manometry, and rectal biopsy all aid in the diagnosis.
References
NMS Pediatrics. Lippincott Williams and Wilkins. 4th Edition. Paul Dworkin editor.
