Hirschsprung disease — MRCPCH FOP MCQ

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ModerateGastroenterologyHirschsprung diseaseMRCPCH FOP

A 3-week-old boy has abdominal distension and poor feeding. He passed meconium at 60 hours, has explosive stool after rectal examination and has poor weight gain. What is the most likely diagnosis?

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Correct answer: D — Hirschsprung disease

Delayed meconium, distension, poor feeding and explosive stool after rectal examination are classic for Hirschsprung disease. Functional constipation is uncommon as a primary explanation in a neonate with delayed meconium and poor growth. Pyloric stenosis causes non-bilious vomiting and metabolic alkalosis rather than delayed meconium. The pearl is that constipation from birth is a red flag.

Reference: NICE CG99 Constipation in children; Paediatric surgery guidance