An abdominal Xray usually shows evidence of distal obstruction in cases of
rectosigmoid Hirschprung. A contrast enema would show differential width between the
affected (spasm/narrowed) or normal (dilated) bowel. In neonates, there may not be a
significant difference between these segments. It is also noted that there is delay in
contrast elimination.
The gold standard in establishing the diagnosis of Hirschprung diseas is suction
rectal biopsy. At the bedside, 3 biopsies [2 lateral and one posterior—1 cm from anal
verge] are obtained of the rectal submucosa to look for Meissner’s plexi.
Management
There are institutional differences in the approach to definitive management of
Hirschprung disease. In some institutions, once the diagnosis is established, .feeds are
resumed and rectal irrigations are initiated every 4-6 hours to evacuate the rectum. The
patient is sent home with irrigations and theoperation “pullthrough’”is performed in 4- 8
weeks.
If the baby not doing well with washouts, the pullthrough is performed earlier, or if there
is long segment disease, an ileostomy is created.
More commonly, definitive treatment is performed prior to discharge. One of
several abdominal-perineal pull-through techniques is peformed. The principles of the
operation is to definitively identify the level where the normal bowel transitions to the
agangllionated segment. The abnormal segment is removed and the ganglionated
proximal colon anastomosed to 1 cm above dentate line. This procedure can be