Delayed presentation of Hirschsprung's disease: acute obstruction secondary to megacolon with transverse colonic volvulus.

Despite advances in the diagnosis of Hirschsprung's disease, occasionally there is still a delay in presentation. We report an unrecognized case of Hirschsprung's disease in a patient who presented at 11 years of age with volvulus of the transverse colon. This is the eighth reported case of colonic volvulus secondary to Hirschsprung's disease in children and the first occurring in the transverse colon. A literature review of other causes of colonic volvulus in children showed only 31 cases occurring in the sigmoid colon and nine in the transverse colon. The treatment of unsuspected colonic volvulus in children is discussed.