A Nine-Year Review of Clinical Presentations, Surgical Management and Outcomes of Hirschsprung’s Disease in a Resource-Limited Setting

Abstract

Background: Hirschsprung’s disease is a common cause of distal intestinal obstruction in children. The patterns of clinical presentation and outcomes vary widely across different settings, influenced by available resources.

Objective: To review the clinical presentation, surgical management, and outcomes of children with Hirschsprung’s disease.

Methods: This was a descriptive, retrospective, case series of children aged 0 to 15 years with Hirschsprung's disease who were treated between January 2015 and December 2023. Data on clinical presentation, surgical treatment, post-operative complications, and mortality were obtained from hospital records for analysis.

Results: The data of 23 children were retrieved for analysis. The male-to-female ratio was 6.7:1, and the median age at presentation was 11 months. Only about one-third presented in the neonatal period. Abdominal swelling (87%) and chronic constipation (70%) were the predominant symptoms, while the short-segment rectosigmoid disease type was most common. The transabdominal Soave–Boley pull-through was performed in 19 children, mainly as a two-stage procedure following colostomy. The most common complications were peristomal dermatitis (39%) and wound infection (30%), while mortality occurred in 13% of the patients. There was no association between age at presentation and stoma-related complications, pull-through–related complications, need for re-operation or mortality.

Conclusion: The clinical presentation of Hirschsprung disease was diverse, though most cases presented after the neonatal period, reflecting barriers to early recognition and referral. Post-operative outcomes were acceptable and comparable to those reported in similar resource-constrained settings.