Evaluation and treatment of the post pull-through Hirschsprung patient who is not doing well; Update for 2022

After operative intervention for Hirschsprung disease (HD) a child should thrive, be fecally continent, and avoid recurrent episodes of abdominal distention and enterocolitis. This is unfortunately not the case for a significant number of patients who struggle following their pull-through procedure....

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Bibliographic Details
Published in:Seminars in pediatric surgery 2022-04, Vol.31 (2), p.151164-151164, Article 151164
Main Authors: Ahmad, Hira, Yacob, Desale, Halleran, Devin R., Gasior, Alessandra C., Lorenzo, Carlo Di, Wood, Richard J., Langer, Jacob C., Levitt, Marc A.
Format: Article
Language:English
Subjects:
Bowel management
Child
Constipation
Digestive System Surgical Procedures - adverse effects
Digestive System Surgical Procedures - methods
Enterocolitis
Enterocolitis - diagnosis
Enterocolitis - etiology
Enterocolitis - therapy
Fecal Incontinence - etiology
Fecal Incontinence - therapy
Hirschsprung disease
Hirschsprung Disease - complications
Hirschsprung Disease - diagnosis
Hirschsprung Disease - surgery
Humans
Incontinence
Obstruction
Post pull-through complications
Postoperative Complications - diagnosis
Reoperation
Soiling
Treatment Outcome
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Summary:After operative intervention for Hirschsprung disease (HD) a child should thrive, be fecally continent, and avoid recurrent episodes of abdominal distention and enterocolitis. This is unfortunately not the case for a significant number of patients who struggle following their pull-through procedure. Many clinicians are puzzled by these outcomes as they can occur in patients who they believe have had a technically satisfactory described operation. This review presents an organized approach to the evaluation and treatment of the post HD pull-through patient who is not doing well. Patients with HD who have problems after their initial operation can have: (1) fecal incontinence, (2) obstructive symptoms, and (3) recurrent episodes of enterocolitis (a more severe subset of obstructive symptoms). After employing a systematic diagnostic approach, successful treatments can be implemented in almost every case. Patients may need medical management (behavioral interventions, dietary changes, laxatives, or mechanical emptying of the colon), a reoperation when a specific anatomic or pathologic cause is identified, or botulinum toxin when non-relaxing sphincters are the cause of the obstructive symptoms or recurrent enterocolitis.
ISSN:1055-8586
1532-9453
DOI:10.1016/j.sempedsurg.2022.151164