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- Irregular bowel movements and constipation are a common complaint pediatric complaint.
- The majority of cases are functional, but providers should take extra care to rule out organic causes like Hirschsprung's disease particularly during the neonatal period.
- 1 in 5000 incidence, with abnormal innervation of the distal colon resulting in tonic contraction, and obstruction of feces.
- In most cases, the agangionic segment is limited to the rectosigmoid area.
- Symptoms usually begin in the first month of life and consist of obstuctive complications such as abdominal distension, bilious vomiting, and poor feeding.
- Rectal examination should be done in all patients with constipation, and often reveals a narrowed high-pressure region adjacent to the anal sphincter.
- Barium enema, anal manometry, and rectal biopsy all aid in the diagnosis.
References
NMS Pediatrics. Lippincott Williams and Wilkins. 4th Edition. Paul Dworkin editor.