Hirschsprung Disease in a 3-Year-Old Boy

Hirschsprung disease is congenital and is due to missing nerve cells in the muscles of the baby’s colon.

On 18^th July 2021 a boy of 3 years was brought by his parents who were both consultants (father psychiatrist and mother ophthalmologist). They asked me if I could offer something for Hirschprung disease. This child had chronic constipation since more than one year. He would pass stool once in 7 days with lots of straining.

Stool was dry and in between hard stools was liquid form (soiling) with mucus. He used to strain for 7 hours at one place in order to be able to pass stool and his face would turn red due to pain. Stool was scanty. His growth was slow till 2 years.

From 3^rd month to the first year he appeared to be a healthy chubby baby and desired to be at the breast for 2-3 hours all the time. His teething, walking and speech were delayed. His weight was not increasing in the last 2 years. He was very cranky for the last 3 weeks.

During pregnancy his mother had guilt for not marrying the boy of her parent’s choice. She was feeling guilty that she was not able to earn and give back to her parents what they had invested in her education. All her life she was a very sincere child dominated by her mother and grew up being afraid to take a stand for herself, except when it came to her marriage. She was experiencing low’s and could not stand criticism. She had great fear of failure. Till the 6^th month of pregnancy she had no interest in herself and a low mood. She suffered post partum blues.

This boy wanted to be very clean and would wash all his cars. He did not like to have a bath. He would be more active at night playing with his ball. He feared water, insects and was fond of dark chocolate. Thermally he was a hot patient. He was very caring towards his elder sister who was apparently healthy.

Appetite- good, demands apples, porridge, guava

Thirstless

Sleep- Prefers to sleep on one side

Family history:

Father- Peptic Ulcer, O.C.D (Washing)

Mother- I.B.S and depression

Paternal Grand Father- Type 1 D.M, Born with staghorn calculi removed one kidney soon after birth, Bypass was done, Expired

Maternal grandfather- Aortic stenosis

Maternal grandmother- Mood swings, O.C.D

On Examination- The right ascending colon was stony hard.

Appearance of child – Very Pale, distressed, afraid, timid, looking down, emaciated, dull, sitting in one position and crying when approached. Child was looking smaller for his age.

Anamnesis of the case:

Here we have a child who has a strong family history of syphilitic miasm yet, his constipation was more psoro-sycotic and it was not congenital. The constipation had made him sedentary. His milestones were delayed. Initially I thought of Carcinosin. However, his constipation alternating with diarrhea (alternating state of symptoms) is a sign of psora) and his tendency for retention of stool is a sign of sycosis.

I used Robin Murphy’s Repertory and the following rubrics 1) Stool changeable           2) Constipation urging to stool, ineffectual. Hirschsprung’s disease involves the terminal rectum. The only remedy was Sulphur which also covers the sedentary life in a child (uncommon). I prescribed Sulphur 0/1 on 18^th July 2021, one dose daily to begin with.

Follow up on 22^nd July 2021 – He is able to pass gas and straining at stool has reduced. Earlier he would pass gas three times a day and now he is able to pass gas all throughout the day and even in his sleep. Passes small quantity of stool little by little, semisolid type.

Now no mucus in stool. Abdomen is still distended however, soft on touch not stony hard. Earlier he would suffer terribly with bloating if he ate a biscuit, two days ago he ate biscuits and had no problems. He is no longer dull but has become playful. Pallor of the face has reduced. Sulphur 0/1 dose reduced to alternate days.

Follow up on 1^st August 2021 – His mother informed that he is doing well and the pediatrician has put him on a stool softener and laxative. In 7 days he will undergo rectal biopsy under anesthesia in order to confirm whether ganglion cells are present in the distal colon. Sulphur 0/1 reduced to twice a week.

Follow up on 8^th August – Since last 5 days he has not passed stools and soiled only twice. Abdomen is swollen and fecal matter can be felt on palpation. Rectal biopsy was postponed to 13^th August 2021. He wants to eat sweet porrige. Goes for bath more readily now. Child was silent, dull, abdomen was soft on examination. Sulphur 0/2 was started daily dose from 8^th August 2021.

Follow up on 17^th August 2021 –His father informed me that the boy is not well. He is straining all the time and not taking enough food and water, just like before. I increased his dose to Sulphur 0/2 twice a day.

Follow up 0n 18^th August 2021– Rectal biopsy was done successfully and histopathology report confirms the diagnosis of Hirschprung’s disease with no ganglion cells present. He is passing stools better than before but the straining still persisted. Same medicine was continued with reassurance to the father.

Follow up on 19^th September 2021 – Yesterday patient passed normal stool, well formed. He gets nightmares. Overall 60% improved. He has good appetite and asks for food. He was also given enemas every day as per guidance of their pediatrician. For the first time I saw this child jumping and playing in my clinic. He was also talking and smiling. Abdomen was very soft on palpation. Prescription given was Sulphur 0/2 reduced to once a week.

Follow up on 31^st October 2021 – Eating has increased to double the quantity. Shows more confidence. He stopped breastfeeding during the day. Able to pass stools without any help. Stool is hard. Stool softener has been prescribed by the pediatrician to make the process painless. Drinks less water. Sulphur 0/3 was prescribed once a week.

Follow up on 3^rd December 2021 – Child is mentally cheerful, playful, very energetic and confident. Great appetite. No distension of abdomen, passing stools once or twice a day. Weight gained in the last 4 months is 3kgs. Also can used to strangers in a short time than before. He has also started to talk a lot and is willing to share his things with others.

Follow up on 18^th December 2021– Child is well and playful. The family has relocated themselves to another state and child has no complaints. Continues to be on Sulphur 0/3 once a week. A repeat of Barium enema has been advised to ascertain the extent of recovery. 

This case evokes certain questions as to how homoeopathic medicines were able to manage this child suffering from Hirschprung disease in absence of ganglion cells. I believe homoeopathy has always something at the back to offer for hopeless cases. Hopeless because the best pediatric surgeons in Jehangir hospital Pune, India were planning for a 3-stage surgical procedure. Homoeopathy rewarded this child of 3 years and his parents for never giving up.

 Four Lab reports below: