WOFAPS 2025 8th World Congress of Pediatric Surgery

Lisa Okbe, Till-Martin Theilen, Yannick Braun, Henning Fiegel, Udo Rolle

Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany

Aim of the Study: Rectal biopsies are of outmost importance in the diagnostic work-up of Hirschsprung disease (HD). This study was undertaken to reveal predictors for positive rectal biopsies in HD. The aim of this retrospective study was to investigate the correlation of clinical symptoms and the diagnostic value of rectal biopsies in the diagnosis of Hirschsprung disease.

Methods: 62 patients aged 0-17 years met the inclusion criteria (2016-2023). Demographic data and clinical parameters of the patients were analyzed, including maturity, non-regular meconium passage, bilious vomiting, abdominal distension, stool-empty rectum, CRP elevation, leukocytosis, constipation and bloody stools. Long-term follow-up was also studied. Descriptive statistical methods were utilized, as the Fisher Exact Test.

Main Results: 30/62 (48%) patients were diagnosed with HD. Most of our patients were diagnosed for HD in infancy (53.3%). No complications of rectal biopsies occurred. A significant correlation for the parameters "abdominal distension" and "non-regular meconium passage" with a positive rectal biopsy was found. Delayed or absent meconium discharge and a stool-empty rectum were shown to be positive predictors of a positive biopsy, whereas a stool-filled rectum was a negative predictor of a positive diagnosis.

Conclusions: Abdominal distension combined with delayed meconium passage are strong predictors for a positive rectal biopsy in the diagnosis of HD in the infant age. We propose to proceed straight to rectal biopsies in this age group, avoiding unnecessary radiological examinations.