Clinical Lecture on the Consequences of Long Continued Constipation

Hirschsprung's disease: Historical notes and pathological diagnosis on the occasion of the 100(th) anniversary of Dr. Harald Hirschsprung's death

Hirschsprung's disease (HSCR) or congenital megacolon is one of the differential diagnoses of chronic constipation mostly in infancy and may indeed represent a challenge for pediatricians, pediatric surgeons, and pediatric pathologists. The diagnosis relies clearly on the identification of the absence of ganglion cells at the plexuses (submucosus and myentericus) of the bowel wall. HSCR is usually located at the terminal (distal) rectum with potential pre-terminal or proximal extension to the less distal large bowel (sigmoid colon). Astonishingly, there is some evidence that Hindu surgeons of prehistoric India may have been exposed and had considerable knowledge about HSCR, but this disease is notoriously and eponymously named to Dr. Harald Hirschsprung (1830-1916), who brilliantly presented two infants with fatal constipation at the Berlin conference of the German Society of Pediatrics more than one century ago. Historical milestones and diagnosis of HSCR (originally called "Die Hirschsprungsche Krankheit") are reviewed. More than 100 years following his meticulous and broad description, HSCR is still a puzzling disease for both diagnosis and treatment. HSCR remains a critical area of clinical pediatrics and pediatric surgery and an intense area of investigation for both molecular and developmental biologists.

Life after Definitive Treatment for Children with Hirschsprung's Disease

PURPOSE

The aim of this study was to investigate the long-term outcomes after definitive surgical correction for children with Hirschsprung's Disease (HD) and the psychosocial impact HD has on the child and family.

METHODS

A clinical-based database of seventy-two children and young people aged between one to twenty-four years with HD, along with their families were investigated. This study involved the development of a condition-specific questionnaire in order to assess the functional and psychosocial outcomes for children with HD at different age groups, combined with parental perception of their child's condition in the long-term.

RESULTS

The greatest functional problem after definitive surgery for HD was faecal soiling (n = 29/38: 76.3%). Children < or = 12 years experienced more embarrassment, distress/discomfort and family difficulties (n = 53/72; 73.6%) due to bowel dysfunctioning (such as faecal soiling) in comparison to children 12 years (n = 19/72; 26.3%) (p < 0.05). Young adults with HD (> 12 years) remained confident and 62.5% hopeful about their future with HD. Nine (12.5%) of the parents reported that HD had a negative impact on their marital relationship due to the daily stressors. Yet, 58.3% (n = 42) families remain confident and 70.8% (n = 42) hopeful about their child's future with HD.

CONCLUSION

Bowel functioning and psychosocial distress improves with increasing age and parental and medical professional support. Psychosocial difficulties found in the child and family with HD are condition-specific--thus improving complications such as faecal soiling will further enhance better psychosocial adjustment.

Hirschsprung's disease: an historical review

A historical review of Hirschsprung's disease is of relevance for several reasons. The historical events are revealing as to how clinical diseases are often slowly unravelled. In addition, many unsolved problems are highlighted. Firstly the exact cause is unknown. There is obviously an interaction between genetic and environmental factors, the nature of which is of interest to basic scientists as well as clinicians. Secondly the pathophysiological explanation for the functional obstruction, and especially its variability, is still incomplete. Much more needs to be known about normal gastrointestinal physiology before this question can be fully answered. Thirdly the technique and timing of operative correction remains inconclusive. Despite extensive postoperative assessment there is no one operation that is clear superior. Each have characteristic problems, but all share the main problem; the abnormal internal sphincter. It remains uncertain how much (if any) of the sphincter should be bypassed. As well the optimal timing of operation is uncertain, with some theoretical advantages being suggested for earlier operation. However, these advantages need to be balanced against possible technical problems. Nevertheless the aim of surgical correction should be the full attainment of normal faecal continence.