#69 Predicting the odds of Hirschsprung’s disease in children referred to pediatric surgery
Yu Qi Wu, The University of Winnipeg; Suyin Lum Min, University of Manitoba
Hirschsprung’s disease (HD) is one of the few known organic causes of constipation. Work-up of patients suspected of having HD may include history and physical, contrast enema and/or manometry. However, only biopsy is diagnostic. Rectal biopsy has proven safe but complications have been reported. Since only 15% of biopsies are positive for HD, surgeons have attempted to define the signs and symptoms predictive of HD. Abdominal distention, failure to thrive, delayed meconium, early onset of symptoms and abnormal contrast enema are more common in HD than functional constipation. However, we are presently unable to predict the odds of HD when patients present to surgical clinic with any or some of these symptoms. This information would help decide if biopsy is warranted. The primary objective was to determine the incidence of HD in patients referred to pediatric surgery. The secondary objective was to determine which clinical features were most predictive of HD.
All referrals to HSC pediatric surgery from 2006 to 2017 were screened for complaints of constipation, abdominal distension, failure to thrive and failure to pass meconium within 48 hours of birth. Patients were grouped according to age at assessment and at onset of symptoms. Data collected included age at the time of surgical assessment, age at onset of symptoms and contrast study and/or biopsy results.
350 patients were included. 12% of all referrals had HD. For constipated patients assessed after 1 year-of-age the incidence was 4%; and if these patients’ constipation started after their first birthday the likelihood of a positive biopsy was 2%.
The incidence of HD in patients referred to surgery for possible HD is 12%. Rectal biopsy is rarely indicated for constipated patients referred after 1 year-of-age.