Related Experiment Video
Updated: May 17, 2026
Diagnosis of Hirschsprung's Disease by Immunostaining Rectal Suction Biopsies for Calretinin, S100 Protein and Protein Gene Product 9.5
Published on: April 26, 2019
Hirschsprung's Disease: a Clinical and Pathologic Study in Iranian Constipated Children
Maryam Monajemzadeh1, Mehdi Kalantari, Bahareh Yaghmai
1Department of Pathology, Tehran University of Medical Sciences, Tehran, Iran ; Pediatrics Center of Excellence, Children's Medical Center, Tehran, Iran.
Insights
Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Developmental Biology
Background:
- Hirschsprung's disease (HD) is a congenital condition characterized by the absence of ganglion cells in the bowel wall, leading to functional obstruction.
- Chronic constipation in children can be a symptom of HD, necessitating diagnostic evaluation.
Purpose of the Study:
- To determine the optimal age for diagnosing Hirschsprung's disease (HD) in constipated children.
- To reduce the incidence of unnecessary rectal biopsies by identifying age-specific likelihoods of HD.
Main Methods:
- A retrospective review of 172 rectal biopsies performed on 168 children with chronic constipation over five years.
- Analysis of patient age at biopsy, age of symptom onset, and presence of HD.
Main Results:
- Of 168 children, 127 (75%) were diagnosed with HD.
- The mean age of children with HD at biopsy was 18 months, significantly younger than the mean age of 39 months for all constipated children.
- Constipation onset during the neonatal period was strongly associated with HD (91% of cases).
Conclusions:
- Constipation presenting after the neonatal period is unlikely to be indicative of Hirschsprung's disease.
- Delayed meconium passage in neonates is a critical early sign of HD, guiding diagnostic decisions.
Objective:
Hirschsprung's disease (HD) is a complex disorder resulting from absence of ganglion cells in the bowel wall leading to functional obstruction and bowel dilatation proximal to the affected segment. The aim of our study was to evaluate rectal biopsies from constipated children in different age groups to see in which age it is more likely to encounter HD to avoid unnecessary rectal biopsy.
Methods:
Records of all children with chronic constipation undergoing a rectal biopsy to exclude HD were obtained from the files of Children's Medical Center in Tehran, Iran. A detailed retrospective demographic review, including age of beginning of signs and symptoms was made of all cases.
Findings:
Totally, 172 biopsies were taken from 168 children in a five year period, of which 127 cases (75%) had HD. The mean age of constipated patients at biopsy was 39 months and the mean age of patients with proven HD was 18 months. Males were affected more than females. Congenital anomalies associated with HD were found in 9.6%. In 85 (91%) cases constipation had begun in neonatal period.
Conclusion:
Our data supports previous studies that if constipation begins after the neonatal period, the child is unlikely to have HD. In neonates delay in meconium passage is the most important clinical sign of HD.
Related Concept Videos
01:25Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
01:17Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
01:30Irritable Bowel Syndrome II: Clinical Features and Diagnostic Evaluation
Irritable Bowel Syndrome (IBS) is classified into subtypes based on the predominant bowel habits as determined by the Bristol Stool Form Scale (BSFS). The subtypes are:
01:07Intestinal Obstruction II: Pathophysiology
01:29Intestinal Obstruction I: Introduction
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD: