A nurse is caring for a child who has Hirschsprung disease. Which of the following findings should the nurse expect?

Hirschsprung disease, also called congenital aganglionic megacolon, is characterized by the absence of ganglion cells in a segment of the colon, which prevents normal peristalsis and results in functional obstruction. Because stool cannot pass normally through the aganglionic segment, it accumulates proximal to the affected area and becomes compacted. When stool does pass, it is typically ribbonlike and foul-smelling due to the prolonged retention and bacterial fermentation. This is the hallmark stool characteristic associated with this condition. Projectile vomiting is more characteristic of pyloric stenosis, in which the pyloric sphincter is hypertrophied and obstructs gastric emptying, not Hirschsprung disease. Chronic hunger is not a primary feature of Hirschsprung disease; in fact, children often have poor appetite due to abdominal distension and discomfort. A ridged abdomen is not a recognized finding associated with Hirschsprung disease; the abdomen is more characteristically distended, not ridged. Additional expected findings include chronic constipation beginning in infancy, failure to thrive, abdominal distension, and in neonates, failure to pass meconium within 48 hours of birth. Recognizing ribbonlike, foul-smelling stools helps distinguish Hirschsprung disease from other gastrointestinal conditions in pediatric patients.