Related Experiment Videos
Primary Swenson's pull-through in children with chronic constipation: a preliminary report
I B Bakare Tajudeen1, T A Badmus, A O Lawal
1Department of Surgery, Federal Medical Centre, Owo, Ondo State, Nigeria.
Insights
Pre-operative saline enema and castor oil improve outcomes for Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Hirschsprung's disease in children often presents with chronic constipation and significant fecal loading.
- Discrepancies in resected end diameters complicate primary pull-through procedures in these patients.
Purpose of the Study:
- To evaluate the efficacy of pre-operative bowel preparation using saline enema and oral castor oil in children with Hirschsprung's disease undergoing primary pull-through surgery.
Main Methods:
- Four pediatric patients with Hirschsprung's disease and chronic constipation received saline enemas and oral castor oil for three weeks pre- and post-operatively.
- Intravenous antibiotics (Cefuroxime or Ceftriaxone plus Metronidazole) were administered.
- Resection levels were standardized proximal to the most contractile colon segment near the transition zone.
Main Results:
- All four patients (aged 5 months to 11 years) with rectosigmoid or descending colon aganglionosis underwent successful primary pull-through.
- Post-operative complications included one case each of anastomotic stenosis, mild enterocolitis, and peri-anal excoriation.
- Patients achieved regular bowel movements (2-4 daily) within one month.
Conclusions:
- Pre-operative bowel preparation with saline enema and oral castor oil appears to facilitate successful primary pull-through procedures in chronically constipated children with Hirschsprung's disease.
- Further prospective studies are warranted to confirm these preliminary findings.
Background:
The discrepancy in diameters of the resected ends coupled with the heavy faecal loads in the colon of chronically constipated children with Hirschsprung's disease makes definitive primary pull-through procedure quite difficulty in this group.
Patients And Methods:
Four consecutive patients (aged 5 months to 11 years) who presented with chronic constipation were given warm saline enema along with Castor oil per oram twice daily for 1 week before and 2 weeks after full-thickness biopsies that confirmed Hirschsprung's disease. All patients had intravenous Cefuroxime or Ceftriaxone plus Metronidazole at induction of anaesthesia. Intra-operatively, the levels of resections were 6-8 cm proximal to the most contractile part of the colon adjacent to the transition zone observed after complete division of mesenteric vessels.
Results:
There were three males and one female, aged 5 months to 11 years. The levels of aganglionosis were in the rectosigmoid region, except one in the descending colon. There was one case each of anastomotic stenoses, mild enterocolitis and deep peri-anal excoriation. The bowel motions were two to four times daily within 1 month post-operatively.
Conclusion:
It can be concluded from this preliminary study that with pre-operative saline enema and oral Castor oil for about 3 weeks in chronically constipated children with Hirschsprung's disease primary pull-through procedures can be performed successfully. However, further prospective work is required with this method.
Related Concept Videos
01:21Drugs for Treatment of Constipation-Predominant IBS
01:17Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
01:22Drugs Affecting GI Tract Motility: Bulk-Forming and Stimulant Laxatives
Bulk-forming laxatives, such as psyllium, methylcellulose, and polycarbophil, absorb water in the intestine, increasing stool bulk and promoting bowel movement. This makes...
01:30Irritable Bowel Syndrome II: Clinical Features and Diagnostic Evaluation
Irritable Bowel Syndrome (IBS) is classified into subtypes based on the predominant bowel habits as determined by the Bristol Stool Form Scale (BSFS). The subtypes are:
01:30Irritable Bowel Syndrome III: Medical and Nursing Management
01:20Drugs Affecting GI Tract Motility: Other Laxatives
Osmotic or saline laxatives, like magnesium hydroxide or milk of...