أعراض الانسداد المستمرة بعد جراحة السحب لمرض هيرشسبرونغ عند غياب السبب الميكانيكي

References

DOI: 10.1186/s13023-020-01362-3

• Children with persistent obstructive symptoms following pull-through surgery should undergo further evaluation and treatment.
• If no mechanical cause is found, a trial of intersphincteric botulinum toxin injections is considered.
• If repeated botulinum toxin injections are ineffective, histology is normal and there is no mechanical cause, bowel management can be offered.
• If symptoms fail to improve after repeated (>3) botulinum toxin injections, bowel management is the second-line choice of treatment.
• Options include regular retrograde enemas or antegrade colonic irrigation via an antegrade continence enema appendicostomy (ACE) or cecostomy +/− dietary modifications +/− laxatives.