An Unsuspected Case of Hirschsprung Disease in an Adolescent: a case report

Introduction: Hirschsprung's disease, a congenital disorder, is characterized by the absence of ganglion cells in the Meissner's plexus of the submucosa and Auerbach's plexus of the muscularis. Notably, late presentation is uncommon, with 95% of cases being diagnosed in infants younger than one year of age. Case presentation: 15-year-old Black female patient presented to our hospital with the compliant of failure to pass feces of 5 days duration associated with abdominal distention. From an early age, she experienced persistent constipation and abdominal distention, leading to multiple admissions to local health centers for enema treatment. Oral laxatives were also prescribed, but they only provided temporary relief of her symptoms. Abdominal x-ray showed significantly dilated bowel loops with fecal loading. Barium enema showed a transition zone at the proximal one-third of the rectum with reversed rectosigmoid ratio. Rectal biopsy confirmed the diagnosis. Decompressive colostomy was done followed by soave pullthrough 3 months later. Conclusion: Adolescent patients with a history of childhood-onset constipation should be evaluated for the possibility of undiagnosed Hirschsprung's disease. Treating this condition can significantly enhance the patient's quality of life.