Some children with Hirschsprung's disease continue to experience obstructive symptoms after pull-through surgery. When rectal examination and contrast enema fail to reveal a mechanical cause for the ongoing obstruction, a structured management pathway is required to guide further evaluation and treatment decisions.
This protocol is indicated when persistent obstructive symptoms follow pull-through surgery and no mechanical cause is identified on rectal examination and contrast enema. Further evaluation is a necessary step before escalating management.
In appropriate cases, surgical re-intervention performed at a specialist centre with experience in complex re-do procedures is part of the management pathway. The full protocol defines which clinical findings warrant this step and the relevant referral criteria.