Treatment of Hirschsprung's Disease with Faecal Incontinence After Pull-Through
This protocol addresses a specific and clinically challenging presentation: a patient with Hirschsprung's disease who has undergone pull-through surgery, has an intact anal canal, and continues to suffer from faecal incontinence alongside a dilated colon with constipation reflecting colonic hypomotility.
Clinical Situation
Post-pull-through faecal incontinence in the setting of an intact anal canal represents an indication for medical management as the first step. When this is complicated by a dilated colon and constipation driven by colonic hypomotility, the priority becomes ensuring regular and complete colonic emptying before continence can be addressed.
Treatment Approach (Partial)
Management centres on a structured bowel management programme. The approach involves methods to achieve predictable, complete colonic evacuation — including forms of colonic irrigation — combined with dietary modification.
The full sequenced regimen, including specific modalities, route selection, and escalation criteria, is available in the complete protocol.
References
- Patients with an intact anal canal and appropriate pull-through but fecal incontinence should receive medical management as the first-line treatment.
- For patients with a dilated colon and constipation (hypomotility), oral laxatives +/− a short course of enemas to ensure regular and complete colonic emptying.
- Proceed to bowel management if there is failure to respond, despite adequate dosing and compliance.
- Options include regular retrograde enemas or antegrade colonic irrigation via an antegrade continence enema appendicostomy (ACE) or cecostomy +/− dietary modifications +/− laxatives.
DOI: 10.1186/s13023-020-01362-3
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