Evaluation and treatment of the patient with Hirschsprung disease who is not doing well after a pull-through procedure
Seminars in Pediatric Surgery
Bowel management; Complications; Enterocolitis; Hirschsprung disease; Incontinence; Obstruction; Pull-through; Soiling
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.
Levitt, M., Dickie, B., & Peña, A. (2010). Evaluation and treatment of the patient with Hirschsprung disease who is not doing well after a pull-through procedure. Seminars in Pediatric Surgery, 19 (2). http://dx.doi.org/10.1053/j.sempedsurg.2009.11.013