Adult Hirschsprung's disease

Hirschsprung's disease in an adult patient with familial occurrence: report of a case

Hirschsprung's disease is almost always associated with newborns or infants; however, we report herein the unusual case of a 46-year-old woman in whom the symptoms of Hirschsprung's disease emerged late in adult life. The involved rectosigmoid region was successfully removed by performing Duhamel's operation with a diverting colostomy. After the colostomy was closed, she regained normal defecatory function. She had one male child affected by Hirschsprung's disease of the total colon type who was operated on as a 12-month-old baby. The genetic predisposition of Hirschsprung's disease has been reported, but its mode of inheritance has not yet been clarified. Moreover, most papers on the familial occurrence of this disease have reported that siblings were affected. Our patient was unique for the definite occurrence of the disease in successive generations. The features of Hirschsprung's disease in adults and the familial occurrence are discussed with a review of the literature.

Rectal biopsy in the investigation of constipation

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.

Adult Hirschsprung's disease. Results of the Duhamel's procedure

Eleven patients with adult Hirschsprung's disease were treated at Seoul National University Hospital (SNUH, 8 cases) and Chosun University Hospital (CUH, 3 cases) between 1985 and 1992. Of the 11 patients, seven were male. The age of the patients ranged from 11 to 30 years, and all presented with chronic constipation and recurrent faecal impactions that required periodic enemas and laxatives. The Duhamel's operation, as a single or staged procedure, was performed in all patients. Levels of aganglionosis in 9 patients were confined to the rectosigmoid colon (82%). There were three major post-operative complications. Two patients developed fistula-in-ano at the anastomotic site, and one patient developed ileus. However, these complications resolved with conservative management. The longterm results were excellent except for one patient who developed impotence. The mean frequency of bowel movements was usually once or twice a day without the aid of other treatments. Our results indicate that Duhamel's operation is a highly acceptable procedure in the management of adult Hirschsprung's disease.