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In Reply.—I did state that when there are classic symptoms of Hirschsprung disease and when the barium enema demonstrates a clear transition between dilated and narrow zone, a rectal biopsy is not routinely indicated. Perhaps I should have underlined the word "routinely." We do occasionally do rectal biopsies in the neonate, particularly when the initial diagnosis is the meconium plug syndrome or when there is suspicion of the microcolon syndrome. We never proceed with a colostomy in the early neonatal period, but allow time for the development of a clear clinical presentation. The only exception to this is in the neonate who clearly has total obstruction that we cannot relieve by rectal irrigations. In most infants, rectal irrigations are so effective that an early colostomy is not necessary.
RAFFENSPERGER JG. Congenital Defects of the Gastrointestinal Tract and Abdominal Wall-Reply. Am J Dis Child. 1976;130(5):567. doi:10.1001/archpedi.1976.02120060113027