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  • Title: Evaluation and treatment of the patient with Hirschsprung disease who is not doing well after a pull-through procedure.
    Author: Levitt MA, Dickie B, Peña A.
    Journal: Semin Pediatr Surg; 2010 May; 19(2):146-53. PubMed ID: 20307851.
    Abstract:
    Ideally, after operative management of Hirschsprung disease, a child should thrive, avoid recurrent episodes of abdominal distention and enterocolitis, and be fecally continent. However, there is a small group of patients that do not do well after their pull-through procedure. The purpose of this article is to describe our algorithm for the work-up and management of the post pull-through patient with Hirschsprung disease who is not doing well. These children can be categorized into 2 distinct groups: (1) those who are soiling, and (2) those who suffer from distention and enterocolitis. Both of these patient types can be systematically treated with a combination of bowel management, dietary changes, and laxatives, and, potentially, a redo operation, with the goal of having a clean, and happy child.
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