Paediatric GI surgery: Hirschsprung disease: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Paediatric GI surgery: Hirschsprung disease

Sample item

A full-term neonate has not passed meconium for 3 days and has abdominal distension and bilious vomiting. A digital rectal examination is followed by an explosive gush of stool and gas, and the distension eases. Which investigation confirms the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Rectal suction biopsy showing absence of ganglion cells

Hirschsprung disease results from failure of neural crest cells to migrate to the distal gut, leaving an aganglionic segment that stays contracted. The definitive diagnosis is histological: absent ganglion cells with hypertrophic nerve trunks and increased acetylcholinesterase staining on a rectal suction biopsy. Contrast enema and radiographs only support the diagnosis.

Option by option

  • A. Plain abdominal radiograph showing dilated bowel loops

    A plain film shows distal obstruction but is non-specific and is also seen in ileal atresia or meconium ileus.

  • B. Anorectal manometry in the neonatal period

    Manometry showing absent rectoanal inhibitory reflex is unreliable in neonates and is used in older children.

  • C. Rectal suction biopsy showing absence of ganglion cells (correct)

    Histology of the rectal wall is the gold standard and confirms aganglionosis.

  • D. Barium enema showing a transition zone

    A barium enema shows a transition zone and delayed evacuation, but it supports rather than confirms the diagnosis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Rectal suction biopsy showing absence of ganglion cells. Hirschsprung disease results from failure of neural crest cells to migrate to the distal gut, leaving an aganglionic segment that stays contracted.

Why is "Plain abdominal radiograph showing dilated bowel loops" not the answer?

A plain film shows distal obstruction but is non-specific and is also seen in ileal atresia or meconium ileus.

Why is "Anorectal manometry in the neonatal period" not the answer?

Manometry showing absent rectoanal inhibitory reflex is unreliable in neonates and is used in older children.

Why is "Barium enema showing a transition zone" not the answer?

A barium enema shows a transition zone and delayed evacuation, but it supports rather than confirms the diagnosis.

What concept does this question test?

It tests Paediatric GI surgery: Hirschsprung disease in General Surgery. The definitive diagnosis is histological: absent ganglion cells with hypertrophic nerve trunks and increased acetylcholinesterase staining on a rectal suction biopsy. Contrast enema and radiographs only support the diagnosis.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric GI surgery: Hirschsprung disease?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.