Clinical Presentations (Hirschsprung´s Disease)

obst_12a_n.jpg: 2-month-old boy with constipation and a protruding belly. Most impressive are the protruding and dilated intestinal loops and the tympanic resonance on percussion due to the high air content. There is no seizable disorder to thrive. In such a clinical presentation the examiner must think of Hirschsprung's disease. The patient is too young for idiopathic constipation, and the clinical presentation is unusual for such cases. obst_12b_n.jpg: 2.9-year-old boy with constipation and failure to thrive. There is a discrepancy between the very large and protruding abdomen and the relatively slim extremities and the corresponding posture. Although the failure to thrive is not so obvious, the ribs of the left lateral chest wall are clearly recognizable. It is the typical clinical presentation of undiagnosed Hirschsprung's disease beyond infancy; in ultrashort types of congenital megacolon the clinical presentation is of course less impressive. A similar clinical picture may also be seen in other chronic diseases of childhood. obst_12c_n.jpg: In this boy the large abdomen with protruding and very dilated intestinal loops attracts attention; so do the visible ribs, indicating the child's nutritional state. It is not to be excluded that such unrecognized cases of Hirschsprung's disease are seen more often in the future, due - among other things - to migration or failed consultation of a medical doctor.