HAEC: Hirschsprung-associated enterocolitis.
* For more details on the evaluation and management of HAEC, refer to UpToDate content on emergency complications of Hirschsprung disease.
¶ Disimpaction is warranted if the lower rectum is dilated with large stool burden. If needed, disimpaction can be done by manual evacuation of impacted hard stool (if palpable within rectal vault) or rectal administration of enemas or suppositories.
Δ Selection of diagnostic tests depends on clinician preference and locally available resources. Considerations include:◊ Infants and children with probable functional constipation should be treated for constipation and observed. If constipation persists despite treatment, the evaluation for Hirschsprung disease should be completed (if not already done).
§ A moderate level of suspicion is also warranted for neonates with well-documented delay in passing meconium but no other signs, symptoms, or risk factors for Hirschsprung disease. Practice varies regarding the evaluation of these infants. At a minimum, they should undergo a careful physical examination and exclusion of other causes of delayed passage of meconium, including anorectal malformations, and should be closely observed and evaluated promptly for Hirschsprung disease if they develop symptoms of constipation or abdominal distension.
¥ The "squirt sign" is a forceful expulsion of gas and stool as the finger is withdrawn from the anus after the digital rectal examination, particularly in infants.