In some patients with Hirschsprung's disease who have undergone pull-through surgery, faecal incontinence persists despite an intact anal canal. When this is accompanied by a dilated colon and constipation due to colonic hypomotility, a specific management pathway applies.
This protocol addresses the subgroup with faecal incontinence following pull-through, where the anal canal is intact and the colon is dilated with ongoing constipation (colonic hypomotility). Medical management is the established first-line approach for patients in this setting.
In isolated cases where the clinical picture does not resolve with medical management, a surgical procedure may be required. The full protocol defines the specific indications, criteria, and structured next steps — see below.
DOI: 10.1186/s13023-020-01362-3
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.
An enterostomy may be required in isolated cases for intractable symptoms.
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