Endoscopic-Assisted Division of Septal Formation After Duhamel Procedure for Hirschsprung Disease: Two Case Reports

The management of septal formation after the Duhamel procedure in Hirschsprung disease remains unclear. We report two cases treated with an endoscopic-assisted approach. Case 1 is a 5-year-old girl with Hirschsprung disease who underwent the Duhamel procedure. Persistent constipation led to a contrast enema, confirming septal formation. Transanal endoscopic-assisted division with an endoscopic linear stapler improved symptoms initially. However, constipation and enterocolitis with bleeding recurred 5 months later, requiring redo surgery. Case 2 is a 21-year-old female with a history of Hirschsprung disease, treated with the Duhamel procedure. She had three episodes of severe abdominal pain and enterocolitis in the past month. Colonoscopy revealed a septal formation with proximal intestinal dilatation. Endoscopic-assisted division resulted in complete resolution of symptoms. No complications occurred. Septal formation may cause an obstruction contributing to constipation and enterocolitis. Early recognition and division of the septum are recommended in patients with severe constipation or enterocolitis after the Duhamel procedure.