AGANGLIONIC MEGACOLON

96

Hirschsprung disease, also known as congenital aganglionic megacolon, is a rare condition occurring during fetal development, primarily impacting the intestines, specifically the colon. The intestine, responsible for food processing, nutrient absorption, and waste elimination, resembles a lengthy tube. The colon, the terminal segment of the intestine, converts digested food into feces for excretion. Hirschsprung disease results from a blockage at the end of the colon due to congenital abnormalities, leading to swelling of the proximal colon.

Causes and Pathology

This congenital abnormality involves the absence of ganglion cells crucial for normal intestinal functions such as absorption and peristalsis. In Hirschsprung disease, parts of the colon lack these cells, causing uncoordinated and chaotic movement, leading to obstruction. Feces accumulate in the affected segments, causing the colon to enlarge, referred to as a “megacolon.” The absence of ganglion cells is a developmental defect, with the rectum being the most affected segment. The affected intestinal segment’s length can vary, being classified as short-segment Hirschsprung disease if below the sigmoid colon, and long-segment megacolon if extending above the descending colon.

Symptoms and Clinical Manifestations

Symptoms of Hirschsprung’s disease vary based on its severity, with some signs potentially emerging later in life, though they typically manifest shortly after birth. Gastroenteritis, affecting up to 40% of children with Hirschsprung’s disease, leads to swelling in both the small and large intestines. The severity of symptoms can range from minimal swelling to severe, sometimes fatal conditions, with severe cases in children characterized by symptoms such as fever and explosive diarrhea.

One prominent indicator is the inability of a newborn to have a bowel movement within 48 hours of delivery. Newborns with Hirschsprung’s disease may exhibit additional signs, including abdominal distension, vomiting (often with a green or brown substance), irritability due to gas or constipation, diarrhea, and delayed passage of meconium (the newborn’s first bowel movement).

In older children, signs and symptoms may include swelling in the stomach, persistent diarrhea, gas, inability to thrive, and exhaustion.

Types of aganglionic megacolon

Hirschsprung’s disease is categorized into two primary forms based on the extent of the large intestine affected:

1. Short-segment Hirschsprung’s Disease:
   • This is the most common type of Hirschsprung’s disease.
   • It involves the absence of nerve cells in the last part of the large intestine.
   • Typically, the affected segment is limited to the area below the sigmoid colon.
2. Long-segment Hirschsprung’s Disease:
   • In this form, the large intestine lacks nerve cells along a more extensive portion.
   • The absence of ganglion cells extends beyond the sigmoid colon, affecting a longer segment of the large intestine.
   • Long-segment Hirschsprung’s disease is less common than the short-segment form but presents with a more widespread absence of nerve cells in the colon

Risk Factors

Factors that can heighten the probability of a child developing Hirschsprung’s disease include:

• Family History: The risk of Hirschsprung’s disease increases when there is a history of the condition in family members.
• Gender: Boys are at a greater risk compared to girls, as Hirschsprung’s disease is more commonly observed in males.
• Down Syndrome: The presence of Down syndrome in a child raises the likelihood of developing Hirschsprung’s disease.
• Other Congenital Defects: The simultaneous existence of other congenital defects or anomalies may contribute to an increased risk of Hirschsprung’s disease.

It’s crucial to emphasize that, although these factors may elevate the chances of the disease, Hirschsprung’s disease can still occur in individuals without these risk factors. Additionally, the precise cause of Hirschsprung’s disease remains not entirely understood, and a combination of genetic and environmental factors is likely involved in its development.

Diagnosis of aganglionic megacolon

Physicians inquire about relevant medical history and conduct examinations, including abdominal X-rays and lower gastrointestinal tract photography, to detect signs of intestinal obstruction. A rectal biopsy confirms the absence of ganglion cells, while anorectal pressure tests provide a diagnostic reference.

Treatment Options for aganglionic megacolon,

Managing Hirschsprung’s disease can be challenging, but early detection enhances the likelihood of a normal life for the child. Physicians typically consider two types of surgery:

1. Pull-through surgery: This procedure involves removing the portion of the large intestine lacking nerve cells, connecting the anus directly to the remaining intestine.
2. Ostomy surgery: In this method, an incision is made in the body to create a passage for the intestines. An ostomy bag, used to collect intestinal waste, is then attached to the outside of the incision. Ostomy surgery is often a temporary solution until the child is ready for pull-through treatment. Early detection and appropriate surgical intervention significantly contribute to the overall well-being of the child with Hirschsprung’s disease

Post-Surgery

After surgery, patients may experience increased bowel movements, gradually improving with anal enlargement rehabilitation. While most achieve good defecation control, some may experience constipation, manageable through dietary control, bowel habits, and, in rare cases, intermittent enemas or re-operation.