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State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease

Elizaveta Bokova1, Ninad Prasade1, Sanjana Janumpally1

  • 1Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO 64108, USA.

Children (Basel, Switzerland)
|August 26, 2023
PubMed

Insights

This review outlines management strategies for Hirschsprung disease (HD) complications like enterocolitis and constipation. It details treatments including laxatives, botulinum toxin injections, and surgical reconstruction for improved bowel management in affected children.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Clinical Management

Background:

  • Hirschsprung disease (HD) can lead to significant complications post-surgery.
  • Common issues include obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, and fecal soiling.

Purpose of the Study:

  • To review current algorithms for the evaluation and treatment of children with Hirschsprung disease.
  • To provide updates on bowel management strategies for HD patients.

Main Methods:

  • Review of existing literature and clinical guidelines on Hirschsprung disease management.
  • Focus on diagnostic and therapeutic algorithms for common HD complications.

Main Results:

  • Constipation management involves excluding anatomical obstruction, followed by laxatives, fiber, or mechanical methods.
  • Botulinum toxin injections are recommended for children under five with non-relaxing sphincters.
  • Sphincter reconstruction is an option for patulous anus, and hypermotility is managed with antidiarrheals and enemas.

Conclusions:

  • Comprehensive management algorithms are essential for addressing diverse complications of Hirschsprung disease.
  • Early detection of HAEC and patient/family education on at-home care are critical.
  • Multifaceted approaches, including medical and surgical interventions, are key to optimizing outcomes in HD patients.

Keywords:
Hirschsprung diseasebotoxbotulinum toxinbowel managementconstipationenemaenterocolitisfecal incontinenceirrigationlaxativesobstructiontotal colonic aganglionosis

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