Evaluation and Management of Persistent Problems After Surgery for Hirschsprung Disease in a Child

Curr Gastroenterol Rep. 2021 Oct 11;23(11):18. doi: 10.1007/s11894-021-00819-0.


Purpose of review: Ideally, after operative intervention, a child born with Hirschsprung disease (HD) should thrive, achieve fecal continence, and avoid recurrent episodes of abdominal distention and enterocolitis. However, a significant number of patients continue to struggle following their pull-through procedure. The purpose of this review is to present an organized and practical approach to the evaluation and management of the symptomatic patient post pull-through operation for HD.

Recent findings: Children diagnosed with HD who are not doing well after their initial operation can be categorized in three distinct groups: (1) those that have fecal incontinence, (2) those with obstructive symptoms, and (3) those with recurrent episodes of enterocolitis. It is important to have a systematic diagnostic approach for these patients based on a comprehensive protocol. All three of these patient groups can be treated with a combination of either medical management, reoperation when a specific anatomic or pathologic etiology is identified, or botulinum toxin for non-relaxing sphincters contributing to the obstructive symptoms or recurrent enterocolitis. For patients not doing well after their initial pull-through, a systematic workup should be employed to determine the etiology. Once identified, a multidisciplinary and organized approach to management of the symptomatic patients can alleviate most post pull-through symptoms.

Keywords: Bowel management; Enterocolitis; Incontinence; Obstruction; Post pull-through complications; Soiling.

Publication types

  • Review

MeSH terms

  • Child
  • Digestive System Surgical Procedures*
  • Enterocolitis* / diagnosis
  • Enterocolitis* / etiology
  • Enterocolitis* / therapy
  • Fecal Incontinence* / etiology
  • Fecal Incontinence* / therapy
  • Hirschsprung Disease* / complications
  • Hirschsprung Disease* / diagnosis
  • Hirschsprung Disease* / surgery
  • Humans
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology
  • Postoperative Complications / therapy
  • Retrospective Studies
  • Treatment Outcome