Adult Hirschsprung's disease: A case report and literature review

Suspicion diagnostic of Hirschsprung's disease in an adult intraoperatively: A case report

Background

Hirschsprung disease, a developmental disorder affecting the neuronal ganglion cells in distal colon, is the leading cause of intestinal obstruction in newborns, predominantly males, although the diagnosis can be made lately in rare cases. We describe an adult Hirschsprung disease case found intraoperatively.

Case description

He is a 20-year-old male patient with past medical history of epilepsy, psychomotor delay and recently a perineal perforating injury, admitted in the emergency room with initial diagnosis of peritonitis by perforated viscus with Frankel grad B spinal cord injury. Among his initial signs and symptoms were abdominal distension, rebound tenderness, decreased bowel sounds and diffuse pain. Laboratory tests revealed increased Hb, decreased white cells count and increased creatinine level. Initial management included: fluid resuscitation, analgesics, antibiotics and laxatives. After becoming hemodynamically unstable, the patient was introduced to the operating room where a highly dilated rectum with areas of necrosis at the base was discovered after access to the abdominal cavity. While doing the intervention, the patient experienced 3 cardiac arrests following by successful ressucitation and blood transfusion; leading to the decision to delay the definitive closure using the Bottega technique. The surgical course was unfavorable as the patient died around 4 hour post-surgery.

Conclusion

Hirschsprung disease in adult, due to its rarity and its overlapping features with many other conditions that can affect the GI system, can be misdiagnosed or discovered lately. A thorough evaluation by an appropriate specialist is essential for adequate diagnosis and management.

Chronic constipation and abdominal distension in a patient with adult Hirschprung's disease and bilateral ovarian teratomas

Hirschprung's disease is a congenital disorder characterized by aganglionic bowel, usually diagnosed in infancy. Here, we present a unique case of Hirschprung's disease diagnosed in a 29-year-old female with acute on chronic constipation. As part of her work up, a computerized tomography of her abdomen and pelvis revealed large, bilateral dermoid cysts. A diagnostic and therapeutic colonoscopy allowed manual disimpaction and decompression of her bowel, as well as biopsy attainment. Histopathology revealed absence of ganglionic cells on haematoxylin and eosin stain and calretinin immunostaining. This case underscores the diagnostic challenges of Adult Hirschprung's disease and how this impacts patient quality of life, as well as the work up and management of concurrent causes abdominopelvic conditions.

Ultrashort-Segment Hirschsprung's Disease Complicated by Megarectum and Obstructive Uropathy: A Case Report

Adult Hirschsprung's disease (AHD) is a rare condition characterized by a shortened aganglionic segment in the distal colon or rectum that is diagnosed after the age of 10. Diagnostic challenges stem from its rarity, nonspecific presentation, and often delayed consideration following emergent interventions. This report details the case of a 33-year-old male who presented with chronic constipation and abdominal pain, leading to a severe bowel obstruction attributed to self-reported Hirschsprung's disease (HD). Clinical, radiological, and historical aspects were suggestive of AHD, but definitive diagnostic procedures, including manometry and biopsy, were hindered by the patient's deteriorating condition. Exploratory laparotomy unveiled a secondary small bowel obstruction due to volvulus, necessitating immediate intervention, resulting in the removal of 4000 cc of fecal material. A comprehensive resection involving mid-to-distal transverse colon, left colon, sigmoid colon, and proximal rectum with the creation of Hartman's colostomy was performed due to the patient's worsening clinical status. We present a case of possible ultrashort-segment Hirschsprung's disease (USHD) and sketch a classic presentation of AHD. This endeavor aims to enhance awareness and consideration of AHD and/or USHD within the spectrum of potential diagnoses for chronic constipation when relevant and demonstrate the effectiveness of surgical intervention in this population.

A Rare Case of Left Hemicolectomy Masking the Signs and Symptoms of Underlying Hirschsprung's Disease in an Adult

Hirschsprung's disease (HD) is a congenital gastrointestinal condition characterized by the lack of ganglion cells within the submucosal and myenteric nervous plexuses in the large intestine. This results in a dysfunctional segment of the large colon, resulting in symptoms such as failure to pass meconium, constipation, and dilated loops of the bowel. The vast majority of patients are diagnosed during the neonatal period, but a handful can be diagnosed later into childhood and adolescence. A rare subset is diagnosed during adulthood, in which the section of the aganglionic colon is minimal yet symptomatic. We report the case of a 54-year-old female presenting with dilated loops of bowel and a remote history of severe constipation, recurrent bowel obstructions, previous left hemicolectomy, and an improvement of symptoms following the procedure. Upon further workup, she was diagnosed with HD, raising the question of whether there should be increased testing for this condition in adults. This case can serve as an example of the need for a more in-depth workup of severe constipation in adults, as the finding for HD in adults is rare but still possible.

Hirschsprung's Disease in Adults Revealed by an Occlusive Syndrome

Hirschsprung's disease (HD) in adults is rare, occurring before the age of five years in 90% of cases. It is characterized by the absence of ganglion cells in a colorectal segment, resulting in functional obstruction and an upstream colonic dilatation.

HD should be considered in front of any history of chronic constipation. The diagnosis is based on a combination of clinical, manometric, radiological, and histological findings. Surgery is the basis of the treatment and consists of the resection of the aganglionic segment, followed by restoration of continuity between the two healthy segments.

We report here the case of a 20-year-old man who presented to the ER with an occlusive syndrome, which initially required a loop colostomy for decompression. History, clinical presentation, and radiological findings were suggestive of HD, but additional diagnostic methods including manometry and biopsy were employed but proved negative. Given the available data, the patient underwent a colectomy with a latero-terminal ileorectal anastomosis. Histological findings of the surgical specimen confirmed the diagnosis of HD.