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Published on: April 26, 2019

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

Marc A Levitt1, Belinda Dickie, Alberto Peña

  • 1Division of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA. Marc.levitt@cchmc.org

Seminars in Pediatric Surgery
|March 24, 2010
PubMed

Insights

Children with Hirschsprung disease not improving after surgery can be helped. This guide outlines a systematic approach to managing post-operative soiling or enterocolitis for better outcomes.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology

Background:

  • Hirschsprung disease (HSCR) requires surgical correction.
  • Some patients experience persistent issues post-operatively, including soiling, distention, and enterocolitis.

Purpose of the Study:

  • To present a structured algorithm for evaluating and managing pediatric patients with Hirschsprung disease who have suboptimal outcomes after pull-through surgery.

Main Methods:

  • Categorization of patients into two groups: those with soiling and those with distention/enterocolitis.
  • Systematic treatment involving bowel management, dietary modifications, and laxatives.
  • Consideration of redo surgery when conservative measures fail.

Main Results:

  • The proposed algorithm provides a clear pathway for addressing post-operative complications.
  • A combination of conservative and surgical interventions can lead to improved patient outcomes.
  • Successful management aims for fecal continence and resolution of enterocolitis.

Conclusions:

  • A defined algorithm is crucial for managing challenging post-operative Hirschsprung disease cases.
  • Tailored management strategies, including bowel care and potential reoperation, are effective.
  • The ultimate goal is to achieve a "clean and happy child" with improved quality of life.

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