of Hirschsprung ' s disease . Microbiological studies of the enterocolitis

The results of a prospective study of 20 cases of newly diagnosed Hirschsprung's disease (nine ofwhom developed enterocolitis) and 10 normal controls showed no variations in the bacterial flora (including Clostridium difficile) in the stools of the groups studied. Viral studies showed that rotavirus was present in the stools of seven of the nine cases of enterocolitis during the episode. We suggest that Hirschsprung's enterocolitis may have a complex infective aetiology and that rotavirus plays a part. Subdepartment of Paediatric Surgery, The Children's Hospital, Western Bank, Sheffield S1O 2TH D Wilson-Storey K G McGenity Western General Hospital, Edinburgh W G Scobie Correspondence to: Mr Wilson-Storey. Accepted 4 June 1990 Hirschsprung's disease (congenital intestinal aganglionosis) is an important cause of functional intestinal obstruction in childhood occurring once in every 5000 live births.' The most severe, potentially life threatening complication is Hirschsprung's enterocolitis, and it is estimated that 5% of patients with Hirschsprung's disease will die of it. It can occur at any time during the course of the disease, irrespective of age, sex, or method or timing of management,24 and is characterised by abdominal distension, diarrhoea, fever, and hypovolaemic shock. Vomiting is an uncommon feature. The diagnosis is made clinically and confirmed radiologically showing colonic dilatation, mucosal ulceration, gastrointestinal hypermotility and sometimes pneumatosis coli-although this is less common in Hirschsprung's than in necrotising enterocolitis. The aetiology of Hirschsprung's enterocolitis is uncertain, although many theories have been advanced including proximal colonic dilatation with resultant mucosal ischaemia and bacterial invasion,5 and hypersensitivity to bacterial antigens.6 More recently, Clostridium difficile and its toxin have been implicated,7 8 although many healthy neonates and infants excrete toxin secreting C difficile in their stools.9 10 The aim of this study was to assess prospectively the microbiological flora (bacterial and viral) in the faeces of newly diagnosed patients with Hirschsprung's disease to find out if any changes occurred in those who subsequently developed enterocolitis. Patients and methods During a three year period 20 new cases of Hirschsprung's disease were diagnosed. Of these, nine subsequently developed enterocolitis. Ten normal age and sex matched control patients from the same hospital ward but not with gastrointestinal conditions (circumcision, orchidopexy, and external angular dermoid cystectomy) were also studied. No patient had suffered from, or had been in contact with, diarrhoea or vomiting before or during this admission to hospital.