title: Hirschsprung disease in the older child: diagnostic strategies.
abstract: BACKGROUND
  Hirschsprung disease is usually diagnosed in patients who are younger than 1 year; but in some individuals it is found later in childhood.
  
  
  OBJECTIVE
  This retrospective study is focused on clinical signs and symptoms of Hirschsprung disease in older children.
  
  
  METHODS
  Patients with Hirschsprung disease were included in the study if they were older than 14 months at the time of diagnosis.
  
  
  RESULTS
  Ten patients older than 14 months were diagnosed with Hirschsprung disease; 7 were males and 3 females. In all, 60% had a positive history of recurrent gastrointestinal infection with vomiting and hospitalization. In 6 patients, the final diagnosis was delayed because of unspecific findings in contrast enema. Rectal biopsy confirmed the diagnosis in all patients.
  
  
  CONCLUSIONS
  Contrast enema is not a specific method for diagnosing Hirschsprung disease. Rectal biopsy alone confirms the diagnosis and provides a clear indication for surgery.
authors.affiliation: Department of Paediatric Surgery, Charité University Hospital, Berlin, Germany. stefanie.maerzheuser@charite.de
authors.forename: Stefanie
authors.initials: S
authors.lastname: Maerzheuser
authors.forename: Christian
authors.initials: C
authors.lastname: Bassir
authors.forename: Karin
authors.initials: K
authors.lastname: Rothe
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000209:etiology; D003937:Diagnosis, Differential; D004733:Enema; D005260:Female; D006627:Hirschsprung Disease / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007223:Infant; D008297:Male; D010808:Physical Examination; D012007:Rectum / Q000473:pathology*; D012189:Retrospective Studies; D014839:Vomiting / Q000209:etiology