Evaluation and Management of Persistent Problems After Surgery for Hirschsprung Disease in a Child.

Abstract

PURPOSE OF REVIEW:

Ideally, after operative intervention, a child born with Hirschsprung disease (HD) should thrive, achieve fecal continence, and avoid recurrent episodes of abdominal distention and enterocolitis. However, a significant number of patients continue to struggle following their pull-through procedure. The purpose of this review is to present an organized and practical approach to the evaluation and management of the symptomatic patient post pull-through operation for HD.

RECENT FINDINGS:

Children diagnosed with HD who are not doing well after their initial operation can be categorized in three distinct groups: (1) those that have fecal incontinence, (2) those with obstructive symptoms, and (3) those with recurrent episodes of enterocolitis. It is important to have a systematic diagnostic approach for these patients based on a comprehensive protocol. All three of these patient groups can be treated with a combination of either medical management, reoperation when a specific anatomic or pathologic etiology is identified, or botulinum toxin for non-relaxing sphincters contributing to the obstructive symptoms or recurrent enterocolitis. For patients not doing well after their initial pull-through, a systematic workup should be employed to determine the etiology. Once identified, a multidisciplinary and organized approach to management of the symptomatic patients can alleviate most post pull-through symptoms.

• Authors: Hira Ahmad, Marc A Levitt, Desale Yacob, Devin R Halleran, Alessandra C Gasior, Carlo Di Lorenzo, Richard J Wood, Jacob C Langer
• Journal: Current gastroenterology reports (Curr Gastroenterol Rep) Vol. 23 Issue 11 Pg. 18 (Oct 11 2021) ISSN: 1534-312X [Electronic] United States
• PMID: 34633517 (Publication Type: Journal Article, Review)
• Copyright: © 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Topics

• Child
• Digestive System Surgical Procedures
• Enterocolitis (diagnosis, etiology, therapy)
• Fecal Incontinence (etiology, therapy)
• Hirschsprung Disease (complications, diagnosis, surgery)
• Humans
• Postoperative Complications (diagnosis, etiology, therapy)
• Retrospective Studies
• Treatment Outcome