Clinical Manifestations
Most children with HD are diagnosed in the first few months of life. Clinical manifestations vary according to the age when symptoms are recognized and the presence of complications, such as enterocolitis (Box 33.5). A neonate usually is seen with distended abdomen, feeding intolerance with bilious vomiting, and delay in the passage of meconium, typically, 95% of normal term infants pass meconiumin in the first 24 hours of life, whereas less than 10% of infants with HD do so. In older children a careful history is helpful.