7.8.2
Hirschsprungs Disease
Malawi Standard Treatment Guidelines, 6th Edition, 2023. Chapter 7, Gastrointestinal Conditions.
Clinical Description
A congenital condition in which the rectum and part of the colon fail to develop a normal system of nerves, leading to an accumulation of faeces in the colon following birth.
Signs and Symptoms
This may be suspected in
- Delayed passage of stools/meconium in a neonate
- Chronic constipation since birth
- Some present later with signs of bowel obstruction (bilious vomiting, abdominal distension), poor feeding and failure to thrive
Investigations
- FBC
- AXR
Non-pharmacological
- This condition has a life-threatening complication of enterocolitis which may present with sepsis and shock from bacterial overgrowth
- These patients need to be referred to a tertiary hospital.
Pharmacological
A rectal washout and antibiotics (Ceftriaxone 50mg/kg/dose and Metronidazole 7.5mg/kg/day) may be considered before referral in the event of:
- Abdominal distension
- Vomiting
- Fever
- Gush of stools on DRE.
*These are signs of an enterocolitis
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