The burden of delayed diagnosis in Hirschsprung disease: insights from a Paediatric Colorectal Centre in South Africa

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BACKGROUND: Delayed diagnosis of Hirschsprung disease (HD), defined as diagnosis after 12 months of age, is usually uncommon and, according to some authors, associated with a worse outcome. We aim to report our experience in a tertiary hospital in a Low-and-Middle-Income Country (LMIC). METHODS: Database of the Johannesburg Paediatric Colorectal Clinic, which includes data from all HD patients since 2017. Patients who had pull-through surgery in other hospitals were excluded. The remaining patients were divided into delayed and non-delayed. Demographic and clinical data, including the number and type of surgeries, complications, and functional outcomes, were collected and compared between the two groups using the Mann-Whitney U and Fisher's Exact Test. RESULTS: Of 80 patients with HD, 26 (32.5%) had a delayed diagnosis, with a median age of 3.14 (1-15) years. Of these, 5 patients were excluded from further analyses because they underwent a pull-through elsewhere. Patients with a delayed diagnosis underwent a median of 4 surgical procedures, compared to 3 in those diagnosed earlier (p = 0.013), but 97.5% of them required surgical diagnostic biopsies, compared to 23.8% in the non-delayed group (p < 0.0001). No differences have been noticed in terms of the type of pull-through performed, number of complications and additional procedures required. Incontinence, constipation, and enterocolitis episodes were similar in both groups. CONCLUSIONS: Delayed diagnosis of HD can be a burden for the healthcare system, as these patients usually require more surgical procedures compared to non-delayed patients, but even in a LMIC context, no significant differences have been seen in terms of complications and post-surgical outcomes, as well as bowel function.

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