A 3-day-old neonate with Hirschsprung disease develops sudden onset abdominal distension, bilious vomiting, and bloody diarrhea. Abdominal X-ray shows dilated bowel loops with air-fluid levels. What is the most likely complication?

• A Intussusception
• B Perforation
• C Volvulus
• D Enterocolitis ✓

Explanation

Hirschsprung-associated enterocolitis is the most common and most serious complication of Hirschsprung disease, presenting with abdominal distension, bilious vomiting, and bloody diarrhea. It results from bacterial overgrowth and mucosal ischemia proximal to the aganglionic segment. It is a leading cause of mortality in Hirschsprung disease and requires urgent decompression and antibiotics.

Reference: Coran's Pediatric Surgery, 7th ed.

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