Persistent Obstructive Symptoms After Hirschsprung's Pull-Through Surgery When No Mechanical Cause Is Found
Clinical Scenario
This protocol applies to patients with Hirschsprung's disease who continue to experience obstructive symptoms following pull-through surgery, and in whom rectal examination and contrast enema have excluded a mechanical cause.
Treatment Approach
When no structural explanation is identified, management focuses on a bowel management programme aimed at achieving regular and complete colonic emptying, using a combination of intestinal emptying techniques alongside supportive dietary and pharmacological measures.
The specific techniques, routes, and adjunctive options that make up the full regimen are detailed in the complete 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 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.
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