Published online Jul 27, 2022. doi: 10.4240/wjgs.v14.i7.656
Peer-review started: August 17, 2021
First decision: September 12, 2021
Revised: September 21, 2021
Accepted: June 24, 2022
Article in press: June 24, 2022
Published online: July 27, 2022
Processing time: 344 Days and 5 Hours
In the past years, only a few studies with a limited number of adult patients analyzed clinical features of allied disorders of Hirschsprung’s disease (ADHD), most of which were individual case reports or lacked detailed clinical information. Although many studies have reported patients presenting to the emergency department (ED) with recurrent abdominal symptoms for a number of disorders, there are few data involving ADHD. However, owing to a lack of awareness of the disease, misdiagnoses and mistreatments are common. Severe complications such as perforation, bleeding, malabsorption, and even death in ADHD had been reported by many studies.
To assist ED clinicians in having a more comprehensive understanding of this disease and making an early suspected diagnosis of ADHD more effectively.
We enrolled 53 patients who visited the ED and were eventually diagnosed with ADHD over the past 11 years in our hospital. Their basic information, clinical manifestations, and imaging findings were analyzed. Blood indices were compared between the ADHD and irritable bowel syndrome (IBS) groups.
Adult patients with ADHD had a mean age of 48.8 ± 14.3 years, and 77.4% had been treated before admission. The transverse colon was the most common dilated part (73.6%), and constipation (67.9%) was the most common symptom. ADHD patients can present with uncommon symptoms and false-negative imaging findings. Logistic regression analysis indicated that body mass index (BMI) [odds ratio (OR) = 0.786, P = 0.013], cholinesterase (per 1000 units; OR = 0.693, P = 0.008), and blood chlorine (OR = 0.816, P = 0.022) were determined to be independent related factors between the ADHD and IBS groups. The area under the receiver operating characteristics curve of these three indices combined was 0.812 (P < 0.001).
Emergency physicians should be vigilant regarding patients with chronic constipation, abdominal pain, or abdominal distension, and consider the possibility of ADHD despite its rarity. Abdominal computed tomography examination is recommended as a useful tool in the suspected diagnosis of ADHD. BMI, cholinesterase, and blood chlorine have good discriminative abilities between ADHD and IBS. The nutritional status of adult patients with ADHD is worthy of further attention. Surgical treatment for adult patients with ADHD is important and inevitable.
Core Tip: Emergency physicians should be vigilant regarding patients with chronic constipation, abdominal pain, or abdominal distension, especially those with recurrent and intolerable symptoms. Allied disorders of Hirschsprung’s disease (ADHD) should be considered in such cases despite its rarity. Abdominal computed tomography examination is recommended as a useful tool to make a suspected diagnosis of ADHD. Clinicians should also be wary of uncommon symptoms and false-negative imaging findings. Body mass index, cholinesterase, and blood chlorine have good discriminative abilities between ADHD and irritable bowel syndrome. The nutritional status of adult patients with ADHD is worthy of further attention.