Chronic constipation in a 9-year-old male: a case of Hirschsprung disease with complex transition zone pathology

Hirschsprung disease (HD) is a congenital condition usually diagnosed in neonates, but it can present later in childhood with persistent constipation. We describe the case of a 9-year-old boy with a history of recurrent constipation since infancy, who presented with severe abdominal distension. Radiological investigations revealed a transition zone consistent with Hirschsprung disease, and histopathology showed variable hypoganglionosis. He underwent exploratory laparotomy with a double-barrel colostomy, recovering without complications. This case highlights the diagnostic challenges in older children and emphasises the importance of thorough histopathological sampling in defining transition zones. It also highlights the importance of long-term follow-up, particularly in terms of functional outcomes, for patients with Hirschsprung disease.