Perforation of Intestine (Hirschsprung´s Disease)

obst_10a_n.jpg: Upright abdomen x-ray in an 1-day-old newborn. Both diaphragmatic domes are visible as a thin line. The right lobe of the liver is pushed to the midline by a clear zone, and the stomach is distended by fluid and air. It is a pneumoperitoneum due to intestinal perforation in congenital megacolon, which is a feared complication of Hirschsprung's disease mainly in neonates with enterocolitis. obst_10b_n.jpg: Operative findings in a 4.9-year-old girl with sigmoid perforation. The demonstrated segment of the sigmoid has localized white or blue-red discolorated parts and stripped off yellow coats. It is a perforation of the sigmoid due to a neuronal colon dysplasia which occurred distally from the megacolon. Spontaeous colonic perforation occurs mostly in Hirschsprung's disease and mainly in the neonatal period. Prior to this typical complication, often a symtomatic localized necrotizing enterocolitis occurs in the megarectum recognizable as fine traces of air in the intestinal wall.