Persistent Obstructive Symptoms After Pull-Through Surgery: Management When No Mechanical Cause Is Found
Pull-through surgery corrects the structural defect in Hirschsprung's disease, yet some children continue to experience obstructive symptoms postoperatively. When rectal examination and contrast enema exclude a mechanical explanation, a specific functional approach is indicated.
Clinical scenario: Persistent obstructive symptoms following pull-through surgery, with no mechanical cause identified on rectal examination and contrast enema.
Children presenting in this scenario require further evaluation and targeted treatment. The absence of a mechanical cause directs attention to functional dysfunction at the level of the internal sphincter as the driver of ongoing obstruction.
First-line approach: When mechanical obstruction has been excluded, management involves a localised injection-based intervention directed at the internal sphincter. The specific intervention and its structured application are set out in the full protocol.
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.
- If no mechanical cause is found, first-line treatment is intersphincteric botulinum toxin injections to relieve internal sphincter achalasia.