Differentiating Hirschsprung's Disease from other Diseases: Difference between revisions
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*[[Small left colon syndrome]] | *[[Small left colon syndrome]] | ||
*[[Intestinal atresia|Distal small bowel /colonic atresia]] | *[[Intestinal atresia|Distal small bowel /colonic atresia]] | ||
*[[Meconium ileus]] and [[cystic fibrosis]] complex | *[[Meconium ileus]] and [[cystic fibrosis]] complex<ref name="pmid14237408">{{cite journal |vauthors=HOLSCLAW DS, ECKSTEIN HB, NIXON HH |title=MECONIUM ILEUS. A 20-YEAR REVIEW OF 109 CASES |journal=Am. J. Dis. Child. |volume=109 |issue= |pages=101–13 |year=1965 |pmid=14237408 |doi= |url=}}</ref> | ||
*[[Congenital hypothyroidism]] | *[[Congenital hypothyroidism]] | ||
{| class="wikitable" | {| class="wikitable" | ||
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* Transient [[intestinal obstruction]] for 1-2 days after birth. | * Transient [[intestinal obstruction]] for 1-2 days after birth. | ||
* Obstruction is functional due to dilated colon and delayed passage of feces. | * Obstruction is functional due to dilated colon and delayed passage of feces. | ||
* Usually seen in [[premature infants]]. | * Usually seen in [[premature infants]].<ref name="pmid18485962">{{cite journal |vauthors=Keckler SJ, St Peter SD, Spilde TL, Tsao K, Ostlie DJ, Holcomb GW, Snyder CL |title=Current significance of meconium plug syndrome |journal=J. Pediatr. Surg. |volume=43 |issue=5 |pages=896–8 |year=2008 |pmid=18485962 |pmc=3086204 |doi=10.1016/j.jpedsurg.2007.12.035 |url=}}</ref> | ||
|[[Image:Meconium-plug-syndrome - Case courtesy of Radswiki, Radiopaedia.org, rID 11606.jpg|center|300px|thumb|Abdominal X-ray with contrast showing inspissated meconium in the intestine proximal to the colon - Case courtesy of Radswiki, Radiopaedia.org, rID 11606]] | |[[Image:Meconium-plug-syndrome - Case courtesy of Radswiki, Radiopaedia.org, rID 11606.jpg|center|300px|thumb|Abdominal X-ray with contrast showing inspissated meconium in the intestine proximal to the colon - Case courtesy of Radswiki, Radiopaedia.org, rID 11606]] | ||
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* Reduced caliber of the [[colon]] starting from [[splenic flexure]] and going down causing [[intestinal obstruction]]. | * Reduced caliber of the [[colon]] starting from [[splenic flexure]] and going down causing [[intestinal obstruction]]. | ||
* Characterized by a sudden change of the diameter of the colon. | * Characterized by a sudden change of the diameter of the colon. | ||
* Usually associated with [[gestational diabetes]]. | * Usually associated with [[gestational diabetes]].<ref name="pmid910057">{{cite journal |vauthors=Berdon WE, Slovis TL, Campbell JB, Baker DH, Haller JO |title=Neonatal small left colon syndrome: its relationship to aganglionosis and meconium plug syndrome |journal=Radiology |volume=125 |issue=2 |pages=457–62 |year=1977 |pmid=910057 |doi=10.1148/125.2.457 |url=}}</ref> | ||
|[[Image:Small-left-colon-syndrome-1 - Case courtesy of Dr Eric F Greif, Radiopaedia.org, rID 30024.jpg|center|300px|thumb|Abdominal X-ray with contrast shows decreased caliber of the descending and sigmoid colon, loss of haustration along with filling defects corresponding to retained feces - Case courtesy of Dr Eric F Greif, Radiopaedia.org, rID 30024]] | |[[Image:Small-left-colon-syndrome-1 - Case courtesy of Dr Eric F Greif, Radiopaedia.org, rID 30024.jpg|center|300px|thumb|Abdominal X-ray with contrast shows decreased caliber of the descending and sigmoid colon, loss of haustration along with filling defects corresponding to retained feces - Case courtesy of Dr Eric F Greif, Radiopaedia.org, rID 30024]] | ||
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* Failure to pass [[meconium]] due to failure of recanalization of the intestine. | * Failure to pass [[meconium]] due to failure of recanalization of the intestine. | ||
* Proximal lesions has an earlier onset of symptoms than distal lesions. | * Proximal lesions has an earlier onset of symptoms than distal lesions. | ||
* [[Intestinal atresia|Colonic atresia]] may affect normal children or may be associated with other abnormalities as Hirschsprung disease or [[gastroschisis]]. | * [[Intestinal atresia|Colonic atresia]] may affect normal children or may be associated with other abnormalities as Hirschsprung disease or [[gastroschisis]].{{cite journal |vauthors=Spitz L |title=Observations on the origin of congenital intestinal atresia |journal=S. Afr. Med. J. |volume=96 |issue=9 Pt 2 |pages=864 |year=2006 |pmid=17077911 |doi= |url=}} | ||
|[[Image:Small-bowel-atresia - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID 5959.jpg|center|300px|thumb|Normal appearing colon that is small and unused. Contrast fills the whole colon and passes to the ileum - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID 5959]] | |[[Image:Small-bowel-atresia - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID 5959.jpg|center|300px|thumb|Normal appearing colon that is small and unused. Contrast fills the whole colon and passes to the ileum - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID 5959]] | ||
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* Most cases of [[meconium ileus]] are secondary to [[cystic fibrosis]]. | * Most cases of [[meconium ileus]] are secondary to [[cystic fibrosis]]. | ||
* Typically presents with failure to pass [[meconium]], [[abdominal distension]] with or without vomiting. | * Typically presents with failure to pass [[meconium]], [[abdominal distension]] with or without vomiting. | ||
* [[Meconium ileus]] may first present with complications [[perforation]] and [[volvulus]]. | * [[Meconium ileus]] may first present with complications [[perforation]] and [[volvulus]].<ref name="pmid14237408">{{cite journal |vauthors=HOLSCLAW DS, ECKSTEIN HB, NIXON HH |title=MECONIUM ILEUS. A 20-YEAR REVIEW OF 109 CASES |journal=Am. J. Dis. Child. |volume=109 |issue= |pages=101–13 |year=1965 |pmid=14237408 |doi= |url=}}</ref> | ||
|[[Image:Meconium-ileus-neonate-with-cystic-fibrosis - Case courtesy of Dr Michael Sargent, Radiopaedia.org, rID 6009.jpg|center|300px|thumb|Contrast enema shows inspissated meconium starting from the mid sigmoid colon and going up till the splenic flexure. The colon is normal in diameter ruling out microcolon]] | |[[Image:Meconium-ileus-neonate-with-cystic-fibrosis - Case courtesy of Dr Michael Sargent, Radiopaedia.org, rID 6009.jpg|center|300px|thumb|Contrast enema shows inspissated meconium starting from the mid sigmoid colon and going up till the splenic flexure. The colon is normal in diameter ruling out microcolon]] | ||
|- | |- | ||
|[[Congenital hypothyroidism]] | |[[Congenital hypothyroidism]]<ref name="pmid2295961">{{cite journal |vauthors= |title=Elementary school performance of children with congenital hypothyroidism. New England Congenital Hypothyroidism Collaborative |journal=J. Pediatr. |volume=116 |issue=1 |pages=27–32 |year=1990 |pmid=2295961 |doi= |url=}}</ref> | ||
|*Most infants are born asymptomatic. | |*Most infants are born asymptomatic. | ||
*[[Macroglossia]] | *[[Macroglossia]] | ||
Revision as of 14:37, 16 June 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]
Overview
Hirschsprung disease must be differentiated from other diseases that cause failure to pass meconium and abdominal distension in infants, such as meconium plug syndrome, small left colon syndrome and congenital hypothyroidism.
Differential Diagnosis
Hirschprung's disease must be differentiated from other diseases in infancy presenting with similar features such as failure to pass meconium, abdominal distension, and non-bilious vomiting.
- Meconium plug syndrome
- Small left colon syndrome
- Distal small bowel /colonic atresia
- Meconium ileus and cystic fibrosis complex[1]
- Congenital hypothyroidism
| Disease | Prominent clinical features | Radiological findings |
|---|---|---|
| Meconium plug syndrome |
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| Small left colon syndrome |
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| Distal small bowel /colonic atresia |
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| Meconium ileus |
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| Congenital hypothyroidism[4] | *Most infants are born asymptomatic.
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References
- ↑ 1.0 1.1 HOLSCLAW DS, ECKSTEIN HB, NIXON HH (1965). "MECONIUM ILEUS. A 20-YEAR REVIEW OF 109 CASES". Am. J. Dis. Child. 109: 101–13. PMID 14237408.
- ↑ Keckler SJ, St Peter SD, Spilde TL, Tsao K, Ostlie DJ, Holcomb GW, Snyder CL (2008). "Current significance of meconium plug syndrome". J. Pediatr. Surg. 43 (5): 896–8. doi:10.1016/j.jpedsurg.2007.12.035. PMC 3086204. PMID 18485962.
- ↑ Berdon WE, Slovis TL, Campbell JB, Baker DH, Haller JO (1977). "Neonatal small left colon syndrome: its relationship to aganglionosis and meconium plug syndrome". Radiology. 125 (2): 457–62. doi:10.1148/125.2.457. PMID 910057.
- ↑ "Elementary school performance of children with congenital hypothyroidism. New England Congenital Hypothyroidism Collaborative". J. Pediatr. 116 (1): 27–32. 1990. PMID 2295961.