Title

Evaluation and treatment of the patient with Hirschsprung disease who is not doing well after a pull-through procedure

Document Type

Journal Article

Publication Date

5-1-2010

Journal

Seminars in Pediatric Surgery

Volume

19

Issue

2

DOI

10.1053/j.sempedsurg.2009.11.013

Keywords

Bowel management; Complications; Enterocolitis; Hirschsprung disease; Incontinence; Obstruction; Pull-through; Soiling

Abstract

Ideally, after operative management of Hirschsprung disease, a child should thrive, avoid recurrent episodes of abdominal distention and enterocolitis, and be fecally continent. However, there is a small group of patients that do not do well after their pull-through procedure. The purpose of this article is to describe our algorithm for the work-up and management of the post pull-through patient with Hirschsprung disease who is not doing well. These children can be categorized into 2 distinct groups: (1) those who are soiling, and (2) those who suffer from distention and enterocolitis. Both of these patient types can be systematically treated with a combination of bowel management, dietary changes, and laxatives, and, potentially, a redo operation, with the goal of having a clean, and happy child. © 2010 Elsevier Inc.

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