title: Pneumoperitoneum in in-vitro Conceived Quadruplet Neonate: Rare Manifestation of Hirschsprung's Disease--Report of a Case.
abstract: BACKGROUND
  Hirschsprung's disease is a congenital colonic aganglionosis, usually presented as inability or difficulty in passing of meconium, chronic and persistent obstipation, maleficent feeding, vomiting, distension and lethargy.
  
  
  METHODS
  We presented a case of an in-vitro conceived quadruplet premature neonate who presented with pneumoperitoneum caused by transverse colon spontaneous perforation and microcolon appearance of distal bowel, treated by resection and temporary colostomy turns to be a rare manifestation of Hirschsprung's disease.
  
  
  CONCLUSIONS
  Assisted reproductive technologies increases chances for multiple pregnancies and may increase chance for major congenital anomalies. Rare manifestation of Hirschsprung's disease is spontaneous pneumoperitoneum which remains a surgical emergency. Delay in recognizing and treatment can significantly worsen prognosis. In neonate with intestinal perforation one should consider Hirschsprung's disease.
authors.affiliation: Department of Surgery, General Hospital Zadar, Zadar, Croatia.
authors.forename: Jakov
authors.initials: J
authors.lastname: Mihanović
authors.affiliation: Department of Pediatric Surgery, Split University Hospital and Split University School of Medicine, Split, Croatia.
authors.forename: Ivo
authors.initials: I
authors.lastname: Jurić
authors.affiliation: Department of Pediatric Surgery, Split University Hospital and Split University School of Medicine, Split, Croatia. zenon@vip.hr.
authors.forename: Zenon
authors.initials: Z
authors.lastname: Pogorelić
authors.affiliation: Department of Pathology, Split University Hospital and Split University School of Medicine, Split, Croatia.
authors.forename: Ivana
authors.initials: I
authors.lastname: Mrklić
authors.affiliation: Department of Pediatric Surgery, Split University Hospital and Split University School of Medicine, Split, Croatia.
authors.forename: Miro
authors.initials: M
authors.lastname: Jukić
authors.affiliation: Department of Pediatric Surgery, Split University Hospital and Split University School of Medicine, Split, Croatia.
authors.forename: Dubravko
authors.initials: D
authors.lastname: Furlan
mesh_terms: D005307:Fertilization in Vitro; D006627:Hirschsprung Disease / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D011027:Pneumoperitoneum / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011783:Quadruplets
keywords: Hirschsprung disease; In vitro fertilization; Pneumoperitoneum; quadruplets