Article Text

Rectal biopsy in the investigation of constipation
  1. MICHAEL WILSCHANSKI,
  2. JOSEPH FABER,
  3. MEIR GOLDBERG,
  4. DAVID BRANSKI
  1. Department of Pediatrics
  2. Shaare Zedek Medical Center
  3. Hebrew University Medical School
  4. PO Box 3235, Jerusalem 91031, Israel

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    Editor,—Ghosh et alconcluded that using rectal biopsy to investigate constipation and, thus, rule out Hirschsprung’s disease, is unnecessary if symptoms begin after the neonatal period.1 We agree with the authors that in most cases there is a history of constipation in the first month of life.

    However, we saw two children recently whose symptoms began at four and five months old, respectively. They had suction rectal biopsy and were subsequently diagnosed with Hirschsprung’s disease, with excellent results after surgery. The parents were unable to provide a neonatal history. A Belgian review supports the view that symptoms can occur first after 1 month of age; they reported that constipation starts, on average, at 38 days.2 Thus, we feel that rectal biopsy may still be useful in atypical cases …

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