There is some understanding of megacolon, but essentially the same, namely a disease caused by a mechanical obstruction caused by inadequate motility of the intestine so that no spontaneous bowel evacuation and inability spinkter rectum relaxes.
Hirschsprung's disease or megacolon is the absence of ganglion cells in the rectum or the rectosigmoid colon. And the lack of these circumstances lead to abnormality or absence of peristalsis and the absence of spontaneous bowel evacuation (Betz, Cecily & Sowden: 2000).
Hirschsprung disease is a congenital anomaly resulting in mechanical obstruction due to lack adekuatan portion of the intestinal motility. (Donna L. Wong, 2003: 507).
Various Kinds of Hirschsprung Disease
Based on the length of the affected segment, can be distinguished two types, namely:
- Short segment Hirschsprung disease. Aganglionosis segments from the anus to the sigmoid; This represents about 70% of cases of Hirschsprung disease and is more common in boys than girls.
- Long segment Hirschsprung disease. Abnormalities may exceed the sigmoid, even the entire colon or small intestine. Found as much in boys and girls. (Ngastiyah, 1997: 138)
Signs and Symptoms
a. The failure of the passage of meconium in the first 24 hours of life.
b. Chronic constipation starting from the first month of life to look like ribbon stool.
c. Intestinal obstruction in the neonatal period.
d. Abdominal pain and distension.
e. Impaired growth.
(Suriadi, 2001: 242)
f. Total obstruction at birth with vomiting, abdominal distension and a lack of evaluation of meconium.
g. Delay followed meconium obstruction periodic evaluation of improved spontaneously or with edema.
h. Mild symptoms of constipation for several weeks or months followed by acute intestinal obstruction.
i. Lightweight construction, enterocolitis with diarrhea, abdominal distension and fever. Fetid diarrhea may be the only symptom.
j. Only mild symptoms of constipation.
(Mansjoer, 2000: 380)
• Neonatal Period:
a. Failed to issue meconium within 48 hours after birth.
b. Vomit contains bile.
c. Reluctant to drink.
d. Abdominal distention.
• The infants and children:
a. constipation
b. recurrent diarrhea
c. Feces such as ribbon, foul-smelling
d. abdominal distention
e. failure to thrive
(Betz, 2002: 197)
Signs and symptoms after birth
1. No expenditure meconium (more than 24 hours of delay)
2. Vomiting green
3. Abdominal distension, constipation.
4. Diarrhea is the most prominent with excessive fecal expenses / spending a lot of gas.
Symptoms in older children because the symptoms are not apparent at birth.
1. A history of constipation at birth
2. Abdominal distention increased
3. Attacks constipation and diarrhea occur alternately
4. Bothered collapsed because of frequent diarrhea.
5. Liquid stool, and grains such as tape.
6. Large and bulging belly.
7. lethargy
8. Problems in the absorption of nutrients, which leads to weight loss, diarrhea or both, and delay or slow growth.
9. Colon infection, especially newborn or very young, which can include enterocolitis, a serious infection with diarrhea, fever and vomiting and sometimes dangerous colonic dilatation.
• In children or older adults, symptoms may include constipation and low values of red blood cells (anemia) due to blood loss in the stool is also accompanied by leukocytosis.
Management
Surgery Hirschsprung conducted in 2 phases, namely conducted colostomy loop or double-barrel so that the tone and size of intestinal dilatation and hypertrophy can be back to normal (takes 3-4 months), followed by one of the three following procedures:
1. Duhamel Procedure: Withdrawal under the direction of normal colon and colon aganglionic menganastomosiskannya behind.
2. Swenson Procedure: Do end-to-end anastomosis of the colon to the anal canal ganglion restricted.
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