2 yr old with rectal biopsy confirmed Hirschsprung's dx. Had transanal Swenson's pull through. Intraop frozen section and Postop histopathology confirmed ganglion cells in pulled through margin. Patient had transient urinary retention that resolved in a few days. Started to have constipation after 2months of surgery. What are the management options available? Personal experiences will be appreciated.
The distal stump below your 'colo-anal anastomosis' and/or the anal sphincters may still be aganglionic. Distal myotomy or SLIS (subcutaneous lateral internal sphinterotomy) may help. Remember to exclude dietary constipation which is on the increase in Nigerian children.
Dear colleague: According to me, you never be in a hurry, the patient has been surgical operation before two months. So follow a little time with dilatation and rectal enema. You know the Hirschsprung’s disease is a difficult and complex disease. After 3 months, reassess the patient with the following considerations; rectal biopsy, barium enema and anorectal manometry, neuronal intestinal dysplasia and other bowel dysmotility. I hope everything goes successfully.
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