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Absorptive function of the aganglionic ileum

P K Kottmeier, B Jongco, F T Velcek

    Journal of Pediatric Surgery
    |June 1, 1981
    PubMed
    Summary
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    In children with Hirschsprung disease, surgical interventions for aganglionic segments can cause malabsorption. The Martin-Duhamel operation and similar techniques can improve fluid absorption by reducing intestinal transit time.

    Area of Science:

    • Pediatric Surgery
    • Gastroenterology
    • Developmental Biology

    Background:

    • Hirschsprung disease involves aganglionosis of the colon and/or ileum.
    • Standard surgical treatments like resection or bypass can lead to malabsorption due to impaired fluid absorption in the terminal ileum.
    • Reducing intestinal transit time is crucial for optimizing fluid absorption.

    Observation:

    • The Martin-Duhamel operation is effective for colonic and short ileal aganglionosis.
    • In cases with longer aganglionic ileal segments, transit time reduction may be insufficient.
    • The aganglionic ileum retains absorptive capacity if the obstruction is addressed.

    Findings:

    • An aganglionic-ganglionic iliac anastomosis, mirroring the Martin-Duhamel technique, can preserve the absorptive function of the aganglionic ileum.

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  • This approach effectively reduces intestinal transit time, mitigating malabsorption.
  • Successful application in children with extensive ileal involvement is demonstrated.

    • Implications:

    • This surgical strategy offers a potential solution for malabsorption in children with extensive Hirschsprung disease.
    • Preserving ileal absorptive capacity improves post-operative outcomes and quality of life.
    • Further research into optimizing ileal anastomosis techniques is warranted.