Differential Diagnosis (Hirschsprung´s Disease)

Differential diagnosis of constipation which is an important leading symptom of congenital megacolon. Constipation may be defined as follows: - duration of constipation more than 1 month; - missing stool evacuation within more than 3 days; - hard and goatstool-like or sticky and malodorous stools; - palpable stool masses. Depending on the age and the clinical presentation of Hirschsprung's disease there are other differential diagnoses in addition to those of constipation; namely, the disorders of ileus of the newborn, of enterocolitis, of toxic megacolon, and of failure to thrive. The list of differential diagnoses starts with diseases of the newborn including functional constipations followed by congenital malformations such as disorders of intestinal innervation in which the immaturity $$obst_3??££of the intramural nervous plexus§§ is often not mentioned. Some cases of anal sphincter achalasia and of rectal stenosis may be acquired; also, the so-called anterior perineal anus (anteropositio ani) develops gradually to a complete disturbance of stool evacuation. In addition, surgery in anorectal malformations and in Hirschsprung's disease may be followed by constipation. Prior to using the term 'idiopathic constipation' the numerous pediatric causes of constipation must be excluded (Ludwig S. Constipation. In: Fleischer G, Ludwig S et al. Textbook of pediatric emergency medicine. Baltimore: Williams & Wilkins, 1983).