The Colorectal Quiz Episode 10: Total Colonic Hirschsprung Disease Part 1

After meconium passage, obtaining another contrast image will show the characteristic appearance of Hirschsprung disease

Common causes of failure to pass meconium include Hirschsprung disease, meconium plug syndrome, meconium ileus, and anorectal malformation

Rare causes of failure to pass meconium include small left colon syndrome, hypothyroidism, opiates in the newborn system, magnesium sulfate from maternal preterm labor treatment, milk protein allergy, and microcolon intestinal hypoperistalsis syndrome

Rectal biopsies should be attempted preoperatively before proceeding to the operating room

If the patient is not doing well with irrigations, a procedure such as ileostomy or leveling colostomy is necessary to relieve pressure

Loop ostomies should be avoided in Hirschsprung disease because stool will likely spill into the non-functional part of the colon

A transition zone can often be visualized during surgery (open or laparoscopic), but when it cannot be seen, biopsies should be obtained at multiple levels

It is acceptable to not perform a definitive procedure if only frozen section is available and there is uncertainty about the frozen section diagnosis

Surgeons can wait for final pathology and return another day to perform the pull-through procedure if needed