Hirschsprung's disease is the congenital absence of autonomic ganglia (group of nerve cells) in the smooth muscle wall of the colon, resulting in poor or absent peristalsis (intestinal movement). This results in the accumulation of feces and dilation of the bowel. Usually, the first sign of this disease in the newborn is delayed passage of meconium (first stool of the newborn), but Hirschsprung's disease may cause perforation of the bowel. Three cases of newborns with bowel perforation due to Hirschsprung's disease are presented. Age at the time of referral was 27 hours, 30 hours, and 1 week old; in all cases, failure to pass meconium was the reason for referral. These three cases, plus a review of the literature, revealed that 90 percent of perforations occur in the proximal colon, terminal ileum (small intestine), or appendix. Perforation of the bowel may be related to increased pressure within the intestine. Between 5 and 8 percent of neonatal ileocolic (small bowel to colon) perforations are due to Hirschsprung's disease; the majority are due to necrotizing enterocolitis (severe inflammation of the intestines and colon). If there is no intestinal gas present, or evidence of appendiceal or cecal perforation, Hirschsprung's disease should be considered. If the cause of perforation is Hirschsprung's disease, and correct diagnosis is not made, it may be fatal, or at least result in a stoma (diversion of the bowel to the abdominal wall) without proper innervation. (Consumer Summary produced by Reliance Medical Information, Inc.)