Difference between Hirschprung disease and functional constipation

Both HD and FC are causes of constipation in children, HD being less common

(incidence 1 in 5000). However, it is important to differentiate between the two

as the management strategies are different for each of them. 



Hirschsprung disease

Functional constipation

Passage of meconium

Delayed

Normal (within 48 hour)

Onset of symptoms

< 1 year age

> 1 year age

Stool withholding 

no

May be present

Encopresis

no

May be present

Abdominal distension

May be present

Usually not associated

Failure to thrive

Commonly present in delayed presentation

Usually not a feature

Enterocolitis

As a complication of HD

Not seen

Digital rectal examination

Tight grip of finger, empty rectum  &

Gush of explosive offensive stool as finger is taken out

Stool in rectum

Barium enema: 

Rectosigmoid ratio (R:S)

< 1

> 1

Transitional zone

present

no


RAIR (rectoanal inhibitory reflex)

absent

Present normally

Rectal biopsy

Ganglion cells

absent

present

Nerve bundles

hypertrophied

normal

Ach-esterase staining

6 times more

normal

Calretinin stain 

(Ganglion cell marker)

Negative (no stain)

positive





Reference:

  1. Sabiston textbook of Surgery

  2. Nelson Pediatrics-21st edition

  3. Review articles published in reputed journals

For author information: 

Dr Sabyasachi,

 MD, Pediatrics, (AIIMS, Delhi)

MBBS (CNMCH, Kol)

mail: pedtalkdrsabya@gmail.com

youtube: Ped talk_Dr Sabya


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