Caecal Perforation In A Child With Chronic Constipation Mimicking Hirschsprung Disease: A Case-based Learning Approach
Caecal perforation in children is a rare but life-threatening
surgical emergency, commonly associated with underlying conditions such as
Hirschsprung disease (HD), infection, or inflammatory disorders. We report a
case of a 2-year-old boy who presented with peritonitis and pneumoperitoneum,
with a background history suggestive of Hirschsprung disease, including delayed
passage of meconium and chronic constipation requiring regular enemas.
Emergency laparotomy revealed an isolated caecal perforation with fecal peritonitis.
Primary repair with diversion ileostomy was performed. Multiple full-thickness
biopsies obtained from different segments of the colon demonstrated adequate
ganglion cells, thereby excluding Hirschsprung disease. The postoperative
course was uneventful, and further evaluation established a diagnosis of
functional constipation. This case highlights the diagnostic dilemma between
Hirschsprung disease and functional constipation and underscores that severe,
inadequately managed functional constipation can lead to catastrophic
complications such as colonic perforation.
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