A three-year-old male child presented with constipation and abdominal distension for two years. Imaging showed dilated bowel loops containing feces. Barium enema revealed a transition zone at the rectosigmoid junction with reversal of the normal ratio, consistent with Hirschsprung's disease. Hirschsprung's disease involves absence of ganglion cells in the intestinal wall, causing a contracted nonperistaltic segment above a dilated segment of normal colon. Rectal biopsy is the diagnostic investigation of choice to identify the absence of ganglion cells.

1. MCQ
• A three-year-old male child presents with history of
constipation and abdominal distension for the last two
years. The plain radiograph of abdomen reveals fecal
matter containing distended bowel loops. A barium enema
study done subsequently shows a transition zone at the
rectosigmoid junction with reversal of rectosigmoid
ratio. The most probable diagnosis is: (AIIMS/03)
A. Anal atresia
B. Malrotation of the gut
C. Hirschsprung's disease
D. Congenital megacolon

2. MCQ
• A three-year-old male child presents with history of
constipation and abdominal distension for the last two
years. The plain radiograph of abdomen reveals fecal
matter containing distended bowel loops. A barium enema
study done subsequently shows a transition zone at the
rectosigmoid junction with reversal of rectosigmoid
ratio. The most probable diagnosis is: (AIIMS/03)
A. Anal atresia
B. Malrotation of the gut
C. Hirschsprung's disease
D. Congenital megacolon

3. MCQ
• Regarding mild Hirschsprung's disease in an infant is true:
(LB24th/1153) (AIIMS 99)
A. Normal manometry excludes diagnosis
B. Large ganglion on histology is present
C. Suction rectal biopsy is done
D. Barium enema is essential for diagnosis

4. MCQ
• Regarding mild Hirschsprung's disease in an infant is true:
(LB24th/1153) (AIIMS 99)
A. Normal manometry excludes diagnosis
B. Large ganglion on histology is present
C. Suction rectal biopsy is done
D. Barium enema is essential for diagnosis

5. TEACHING POINT
Hirschsprung's disease- Caused by absence of ganglion cells in the neural
plexus of the intestinal wall, together with hypertrophy of the nerve trunk.
• Usually involves the rectum and lower sigmoid colon
There is contracted nonperistaltic segment with a dilated hypertrophied
segment of normal colon above it.
CAF- More common in males and associated with Down's syndrome
• Presentation is usually on 3rd postnatal day but may be
• Delayed pasage of meconium beyond the first 24 hours of life together
with abdominal distension following feeds and bilous vomiting
• Chronic constipation starting in the first few weeks of life Diagnosis isby
full thickness rectal biopsy
• Treatment usually requires an emergency defunctioning stoma shortly
after birth and major reconstructive procedure later, when child's of
greater than 10 kg.
One stagee procedures are Duhamel's operation and Swenson's operation

6. MCQ
• True about Hirschsprung's disease: (LB24th/1153) (AIIMS 97)
A. Autosomal dominant
B. Loss of ganglion cell from myenteric plexus
C. Loss of ganglion cell from submucous plexus
D. More common in females

7. MCQ
• True about Hirschsprung's disease: (LB24th/1153) (AIIMS 97)
A. Autosomal dominant
B. Loss of ganglion cell from myenteric plexus
C. Loss of ganglion cell from submucous plexus
D. More common in females

8. MCQ
• Investigation of choice to diagnose Hirschsprung's disease is :
(AIIMS/03)
A. Rectal manometry
B. Barium enema
C. Rectal biopsy
D. Laparotomy

9. MCQ
• Investigation of choice to diagnose Hirschsprung's disease is :
(AIIMS/03)
A. Rectal manometry
B. Barium enema
C. Rectal biopsy
D. Laparotomy

10. MCQ
• Aganglionic part of Hirschsprung's disease the common part involved:
(LB24th/1153) (UP 95)
A. Duodenum
B. Ilium
C. Jejunum
D. Rectum

11. MCQ
• Aganglionic part of Hirschsprung's disease the common part involved:
(LB24th/1153) (UP 95)
A. Duodenum
B. Ilium
C. Jejunum
D. Rectum

12. MCQ
• Etiology of Hirschsprung's disease is: (LB24th/1153) (AZIMS 86)
A. Abesence of Meissner's plexus
B. Absence of mesenteric plexus
C. Absence of both
D. None of above

13. MCQ
• Etiology of Hirschsprung's disease is: (LB24th/1153) (AZIMS 86)
A. Abesence of Meissner's plexus
B. Absence of mesenteric plexus
C. Absence of both
D. None of above

14. MCQ
• A three-year-old male child presents with history of constipation and
abdominal distension for the last two years. The plain radiograph of
abdomen reveals fecal matter containing distended bowel loops. A
barium enema study done subsequently shows a transition zone at the
rectosigmoid junction with reversal of rectosigmoid ratio. The most
probable diagnosis is: (AIIMS/03)
A. Anal atresia
B. Malrotation of the gut
C. Hirschsprung's disease
D. Congenital megacolon.

15. MCQ
• A three-year-old male child presents with history of constipation and
abdominal distension for the last two years. The plain radiograph of
abdomen reveals fecal matter containing distended bowel loops. A
barium enema study done subsequently shows a transition zone at the
rectosigmoid junction with reversal of rectosigmoid ratio. The most
probable diagnosis is: (AIIMS/03)
A. Anal atresia
B. Malrotation of the gut
C. Hirschsprung's disease
D. Congenital megacolon.

16. MCQ
• Investigation of choice to diagnose Hirschsprung's disease is :
(AIIMS/03)
A. Rectal manometry
B. Barium enema
C. Rectal biopsy
D. Laparotomy

17. MCQ
• Investigation of choice to diagnose Hirschsprung's disease is :
(AIIMS/03)
A. Rectal manometry
B. Barium enema
C. Rectal biopsy
D. Laparotomy

18. MCQ
• Hirschspurung's disease: (LB24th / 1154) (AIIMS 91)
A. Females>males
B. Appear on 3rd day
C. Anorectal biopsy can be done in doubtful cases
D. Rx is by recurrent oral dilation

19. MCQ
• Hirschspurung's disease: (LB24th / 1154) (AIIMS 91)
A. Females>males
B. Appear on 3rd day
C. Anorectal biopsy can be done in doubtful cases
D. Rx is by recurrent oral dilation

20. MCQ
• Dilated segment in Hirschsprung's disease is: (LB/1027) (AIIMS 99)
A. Proximal to aganglionic segment
B. Distal to aganglionic segment
C. Whole bowel is dilated
D. Itself is aganglionic

21. MCQ
• Dilated segment in Hirschsprung's disease is: (LB/1027) (AIIMS 99)
A. Proximal to aganglionic segment
B. Distal to aganglionic segment
C. Whole bowel is dilated
D. Itself is aganglionic

22. MCQ
• The operative treatment in Hirschsprung's disease is only undertaken
when child: (LB / 1028) (PGI 79, TN 89)
A. Is 2 years of age
B. Is at least 8 kg in weight and thriving
C. Has no distention of abdomen
D. Has failed to respond to conservative treatment

23. MCQ
• The operative treatment in Hirschsprung's disease is only undertaken
when child: (LB / 1028) (PGI 79, TN 89)
A. Is 2 years of age
B. Is at least 8 kg in weight and thriving
C. Has no distention of abdomen
D. Has failed to respond to conservative treatment

24. MCQ
• Following procedures (except one) are done for correction of
Hirschsprung's disease: (LB24th/1155) (JIPMER 91, AIIMS 87)
A. Duhamel's
B. Soave's
C. Swenson's
D. Bayar's

25. MCQ
• Following procedures (except one) are done for correction of
Hirschsprung's disease: (LB24th/1155) (JIPMER 91, AIIMS 87)
A. Duhamel's
B. Soave's
C. Swenson's
D. Bayar's

26. MCQ
• When rectal washouts are given to Hirschsprung's disease the
following fluid is used: (LB24th/1155) (KARN 95)
A. 5% dextrose
B. Normal saline
C. Soap solution
D. Tap water

27. MCQ
• When rectal washouts are given to Hirschsprung's disease the
following fluid is used: (LB24th/1155) (KARN 95)
A. 5% dextrose
B. Normal saline
C. Soap solution
D. Tap water

28. MCQ
• True about Hirschsprung's disease: (LB24th/1153) (AIIMS 97)
A. Autosomal dominant
B. Loss of ganglion cell from myenteric plexus
C. Loss of ganglion cell from submucous plexus
D. ore common in females

29. MCQ
• True about Hirschsprung's disease: (LB24th/1153) (AIIMS 97)
A. Autosomal dominant
B. Loss of ganglion cell from myenteric plexus
C. Loss of ganglion cell from submucous plexus
D. ore common in females

30. MCQ
• Regarding mild Hirschsprung's disease in an infant is true:
(LB24th/1153) (AIIMS 99)
A. Normal manometry excludes diagnosis
B. Large ganglion on histology is present
C. Suction rectal biopsy is done
D. Barium enema is essential for diagnosis

31. MCQ
• Regarding mild Hirschsprung's disease in an infant is true:
(LB24th/1153) (AIIMS 99)
A. Normal manometry excludes diagnosis
B. Large ganglion on histology is present
C. Suction rectal biopsy is done
D. Barium enema is essential for diagnosis

32. MCQ
• Diagnostic of Hirschsprung's disease is: (LB24th l 1154) (UPSC 87,
88)
A. Barium enema
B. Rectal examinations
C. Manometry
D. Rectal biopsy

33. MCQ
• Diagnostic of Hirschsprung's disease is: (LB24th l 1154) (UPSC 87,
88)
A. Barium enema
B. Rectal examinations
C. Manometry
D. Rectal biopsy

34. MCQ
• Dilated segment in Hirschsprung's disease is: (LB/1027) (AIIMS 99)
A. Proximal to aganglionic segment
B. Distal to aganglionic segment
C. Whole bowel is dilated
D. Itself is aganglionic

35. MCQ
• Dilated segment in Hirschsprung's disease is: (LB/1027) (AIIMS 99)
A. Proximal to aganglionic segment
B. Distal to aganglionic segment
C. Whole bowel is dilated
D. Itself is aganglionic

36. MCQ
• The operative treatment in Hirschsprung's disease is only undertaken
when child: (LB / 1028) (PGI 79, TN 89)
A. Is 2 years of age
B. Is at least 8 kg in weight and thriving
C. Has no distention of abdomen
D. Has failed to respond to conservative treatment

37. MCQ
• The operative treatment in Hirschsprung's disease is only undertaken
when child: (LB / 1028) (PGI 79, TN 89)
A. Is 2 years of age
B. Is at least 8 kg in weight and thriving
C. Has no distention of abdomen
D. Has failed to respond to conservative treatment

38. MCQ
• Following procedures (except one) are done for correction of
Hirschsprung's disease: (LB24th/1155) (JIPMER 91, AIIMS 87)
A. Duhamel's
B. Soave's
C. Swenson's
D. Bayar's

39. MCQ
• Following procedures (except one) are done for correction of
Hirschsprung's disease: (LB24th/1155) (JIPMER 91, AIIMS 87)
A. Duhamel's
B. Soave's
C. Swenson's
D. Bayar's

40. MCQ
• When rectal washouts are given to Hirschsprung's disease the
following fluid is used: (LB24th/1155) (KARN 95)
A. 5% dextrose
B. Normal saline
C. Soap solution
D. Tap water

41. MCQ
• When rectal washouts are given to Hirschsprung's disease the
following fluid is used: (LB24th/1155) (KARN 95)
A. 5% dextrose
B. Normal saline
C. Soap solution
D. Tap water

42. MCQ
• Hirschspurung's disease: (LB24th / 1154) (AIIMS 91)
A. Females>males
B. Appear on 3rd day
C. Anorectal biopsy can be done in doubtful cases
D. Rx is by recurrent oral dilation

43. MCQ
• Hirschspurung's disease: (LB24th / 1154) (AIIMS 91)
A. Females>males
B. Appear on 3rd day
C. Anorectal biopsy can be done in doubtful cases
D. Rx is by recurrent oral dilation

44. MCQ
• Hirschsprung's disease is best diagnosed by: (Karnataka 08)
A. Full thickness rectal biopsy
B. Partial thickness rectal biopsy
C. Pressure studies
D. Barium enema

45. MCQ
• Hirschsprung's disease is best diagnosed by: (Karnataka 08)
A. Full thickness rectal biopsy
B. Partial thickness rectal biopsy
C. Pressure studies
D. Barium enema

46. MCQ
• True about Hirschsprung's disease A/E (DNB Dec 07)
A. Aganglionic colon
B. Presents with decreased passage of shoot
C. Never associated with Down's syndrome
D. Thickening of nerve seen

47. MCQ
• True about Hirschsprung's disease A/E (DNB Dec 07)
A. Aganglionic colon
B. Presents with decreased passage of shoot
C. Never associated with Down's syndrome
D. Thickening of nerve seen

48. MCQ
• Regarding Hirschsprung's disease which is true?
A. More in females
B. Presentation within 3 days
C. Rectal biopsy diagnostic (KAR-1 992-93)
D. Regular dilatation effective

49. MCQ
• Regarding Hirschsprung's disease which is true?
A. More in females
B. Presentation within 3 days
C. Rectal biopsy diagnostic (KAR-1 992-93)
D. Regular dilatation effective

50. MCQ
• The fluid used for bowel wash in Hirschpsung's disease is
A. Tap water
B. Normal saline
C. Soap water
D. Glycerol (JIP - 1991)

51. MCQ
• The fluid used for bowel wash in Hirschpsung's disease is
A. Tap water
B. Normal saline
C. Soap water
D. Glycerol (JIP - 1991)

52. MCQ
• In Hirschsprung's disease, the defect lies in
A. Parasympathetic ganglia
B. Sympathetic ganglia
C. Spinal cord
D. Smooth muscle

53. MCQ
• In Hirschsprung's disease, the defect lies in
A. Parasympathetic ganglia
B. Sympathetic ganglia
C. Spinal cord
D. Smooth muscle

54. MCQ
• Which is not true of Hirschsprung's disease?
A. Anal sphincter normal
B. Reduced ganglion cells
C. More in males
D. Diagnosed by biopsy

55. MCQ
• Which is not true of Hirschsprung's disease?
A. Anal sphincter normal
B. Reduced ganglion cells
C. More in males
D. Diagnosed by biopsy

56. MCQ
• In Hirschsprung's disease there is
A. Deficiency of acetylcholine
B. Deficiency of ganglion cells
C. Absence of ganglion cells
D. All of the above

57. MCQ
• In Hirschsprung's disease there is
A. Deficiency of acetylcholine
B. Deficiency of ganglion cells
C. Absence of ganglion cells
D. All of the above

58. MCQ
• Hirschsprung's disease presents usually days after birth
A. 3
B. 7
C. 14
D. 21

59. MCQ
• Hirschsprung's disease presents usually days after birth
A. 3
B. 7
C. 14
D. 21

60. MCQ
• Following are true of clinical picture of Hirschsprung's disease except
A. Failure to pass meconium in 24 hrs
B. Lax anal sphincter
C. Visible peristalsis
D. Empty rectum

61. MCQ
• Following are true of clinical picture of Hirschsprung's disease except
A. Failure to pass meconium in 24 hrs
B. Lax anal sphincter
C. Visible peristalsis
D. Empty rectum

62. MCQ
• Diagnostic of Hirschsprungs disease is ---- 3.72aaaII
A. Barium enema (JIPMER 87)
B. Rectal examination
C. Manometry
D. Rectal biopsy

63. MCQ
• Diagnostic of Hirschsprungs disease is ---- 3.72aaaII
A. Barium enema (JIPMER 87)
B. Rectal examination
C. Manometry
D. Rectal biopsy

64. MCQ
• Which is true regarding Hirschsprungs disease – ---- 3.72aaaII (AIIMS
91)
A. More in females
B. Presentation within 3 days
C. Regular dilatation is effective
D. Rectal biopsy diagnostic

65. MCQ
• Which is true regarding Hirschsprungs disease – ---- 3.72aaaII (AIIMS
91)
A. More in females
B. Presentation within 3 days
C. Regular dilatation is effective
D. Rectal biopsy diagnostic

66. MCQ
• operative treatment in Hirschsprung's diseas is only undertaken when
child ----3.73aaaII (PGI79, TN89,
A. Is 2 years of age
B. Is at least 8 kg in weight and thriving
C. Has no distension of abdomen
D. Has failed to respond to conservative treatment

67. MCQ
• operative treatment in Hirschsprung's diseas is only undertaken when
child ----3.73aaaII (PGI79, TN89,
A. Is 2 years of age
B. Is at least 8 kg in weight and thriving
C. Has no distension of abdomen
D. Has failed to respond to conservative treatment

68. MCQ
• When rectal washouts are given to Hirshsprung's disease, the following
flifluid is used ----3.73aaaII (Karn 95)
A. 5% dextrose
B. Normal saline
C. Soap solution
D. Tap water

69. MCQ
• When rectal washouts are given to Hirshsprung's disease, the following
flifluid is used ----3.73aaaII (Karn 95)
A. 5% dextrose
B. Normal saline
C. Soap solution
D. Tap water

70. MCQ
• Hirschprung's disease is treated by - ---3.74aaaII
A. Colostomy
B. Excision of a ganglionic segment
C. Colectomy
D. Sodium chloride wash

71. MCQ
• Hirschprung's disease is treated by - ---3.74aaaII
A. Colostomy
B. Excision of a ganglionic segment
C. Colectomy
D. Sodium chloride wash

72. MCQ
• Absence of myenteric ganglion is seen in-----3.74aaaII
A. Crohn's disease
B. Ulcerative colitis
C. Hirschprung's disease
D. Intussusception

73. MCQ
• Absence of myenteric ganglion is seen in-----3.74aaaII
A. Crohn's disease
B. Ulcerative colitis
C. Hirschprung's disease
D. Intussusception

74. MCQ
• Investigation of choice in hirschsprug's disease is - ---3.74aaaII
(PGI98)
A. Rectal manometry
B. Rectal examination
C. Rectal biopsy
D. Ba enema

75. MCQ
• Investigation of choice in hirschsprug's disease is - ---3.74aaaII
(PGI98)
A. Rectal manometry
B. Rectal examination
C. Rectal biopsy
D. Ba enema

76. MCQ
• True about Hirschsprung's disease ------3.75aaaII (PGI01)
A. Pathology of myenteric plexus of Auerbach
B. Blood in stools
C. May involve small intestine rarely
D. Involved segment of intestine is dilated
E. Present only in infant & children-----3.75aaaII

77. MCQ
• True about Hirschsprung's disease ------3.75aaaII (PGI01)
A. Pathology of myenteric plexus of Auerbach
B. Blood in stools
C. May involve small intestine rarely
D. Involved segment of intestine is dilated
E. Present only in infant & children-----3.75aaaII

78. MCQ
• Hirchprung's disease - ---3.76aaaII
A. Is seen in infants and children only
B. Absence of ganglia in involved segement
C. The involved segment is the dilated colon
D. Bleeding PR is a presenting feature
E. urgery is used in therapy

79. MCQ
• Hirchprung's disease - ---3.76aaaII
A. Is seen in infants and children only
B. Absence of ganglia in involved segement
C. The involved segment is the dilated colon
D. Bleeding PR is a presenting feature
E. urgery is used in therapy

80. MCQ
• Which of these are associated with increased risk of colorectal ca - ---
3.76aaaII (PG101)
A. More intake of animal fat
B. Aspirin
C. Ulcerative colitis
D. Amoebic colitis
E. Polyps

81. MCQ
• Which of these are associated with increased risk of colorectal ca - ---
3.76aaaII (PG101)
A. More intake of animal fat
B. Aspirin
C. Ulcerative colitis
D. Amoebic colitis
E. Polyps

82. MCQ
• Hirschprung's disease true are ----3.78aaaII (PGIJune 06)
A. Sometimes found in adult
B. Dilated segment involved
C. Auerbach's plexus absent
D. Sometimes involve small intestine
E. Bleeding PR is usual presentation.

83. MCQ
• Hirschprung's disease true are ----3.78aaaII (PGIJune 06)
A. Sometimes found in adult
B. Dilated segment involved
C. Auerbach's plexus absent
D. Sometimes involve small intestine
E. Bleeding PR is usual presentation.

84. MCQ
• Duhamel operation is done in -----3.105aaaII (JIPMER 81,
A. Congenital pyloric stenosis UPSC 89)
B. Hiatus hernia
C. Achlasia cardia
D. Hirschsprung's disease

85. MCQ
• Duhamel operation is done in -----3.105aaaII (JIPMER 81,
A. Congenital pyloric stenosis UPSC 89)
B. Hiatus hernia
C. Achlasia cardia
D. Hirschsprung's disease

86. MCQ
• Aganglionic segment is encountered in which pt of colon in case of
Hirchsprung's disease -----10.14 / aims pgmee questions - nov., 1999
A. Distal to dilated segment
B. In whole colon
C. Proximal to dilated segment
D. In dilated segment

87. MCQ
• Aganglionic segment is encountered in which pt of colon in case of
Hirchsprung's disease -----10.14 / aims pgmee questions - nov., 1999
A. Distal to dilated segment
B. In whole colon
C. Proximal to dilated segment
D. In dilated segment