Allergic proctitis and abdominal distention mimicking Hirschsprung's disease in infants.
OBJECTIVE
To determine the incidence and clinical aspects of allergic proctitis (AP) in infants with symptoms that mimic Hirschsprung's disease (HD).


METHODS
One hundred and five patients less than 6 months of age, who underwent barium enema, anorectal manometry and rectal suction biopsy due to suspicion of HD, were enrolled. Comparison of the patient characteristics associated with each disease was based on the results of the triple testing. The sensitivity and specificity of the three tests, for the diagnosis of HD, were evaluated.


RESULTS
The mean age of enrolled patients was 2.1+/-0.9 months. Based on the three tests, 39 patients (37.1%) were diagnosed with HD, seven patients (6.7%) with AP, and 53 (50.5%) had normal results. Of the 54 patients with transitional zone and a reversed rectosigmoid index on the barium enema, four (7.4%) were patients with AP. The mean age of the AP patients (3.1+/-1.5 months old) was older than the HD children (1.4+/-0.9 months old). The sensitivity of the three tests for HD was 97.4%, 87.2% and 92.3% and the specificity was: 74.2%, 78.8% and 100%, respectively.


CONCLUSIONS
In the infants with severe abdominal distention, the incidence of AP mimicking HD was relatively high. Therefore, consideration of AP should be part of the differential diagnosis in infants with severe abdominal distention or findings that mimic HD. For differentiation of these disorders, a rectal suction biopsy is very useful.
Lee
Jee Hyun
JH
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Choe
Yon Ho
YH
Lee
Suk-Koo
SK
Seo
Jeong Meen
JM
Kim
Ji Hye
JH
Suh
Yeon-Lim
YL
D000005:Abdomen / Q000473:pathology; D001466:Barium Sulfate; D001706:Biopsy / Q000379:methods; D003937:Diagnosis, Differential; D004733:Enema; D017615:Enteric Nervous System / Q000473:pathology; D005260:Female; D006627:Hirschsprung Disease / Q000175:diagnosis*; D006801:Humans; D015994:Incidence; D007223:Infant; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008365:Manometry; D016269:Milk Hypersensitivity / Q000150:complications; D011349:Proctitis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D012007:Rectum / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D001466:Barium Sulfate