Presenter Status
Resident/Ph.D/Post graduate (> 1 month of dedicated research time)
Abstract Type
Research
Primary Mentor
Rebecca M. Rentea, MD, MS
Start Date
12-5-2023 11:30 AM
End Date
12-5-2023 1:30 PM
Presentation Type
Poster-Restricted Access
Description
Background: The main goal of Hirschsprung disease (HD) surgery is to treat functional obstruction. Postoperative care involves continued good bowel emptying to achieve social continence. After an initial pull-through, patients with HD can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or soiling. The potential need for bowel management depends on the timing of the surgery, the length of the aganglionic segment, the technique, and the anatomic success of the pull-through.
Objectives/Goal: Our goal is to report updates on a bowel management program for patients with a colorectal diagnosis (anorectal malformation, Hirschsprung disease, spinal anomaly, and functional constipation) based on recent literature. As part of a manuscript series, this review is focused on the recent updates in evaluating and managing patients with HD.
Methods/Design: We performed a literature review using the Medline/PubMed database, focusing on published research papers over the last 5 years. Of the selected manuscripts and book chapters, 50 were included in this review. The search was performed using the following keywords: bowel management, Hirschsprung disease, botox, soiling, enterocolitis, HAEC, botulinum toxin, irrigations, obstruction, and total colonic.
Results: After the initial pull-though, 8–53.3% of patients experience obstructive symptoms, 25- 37% have HAEC, 7.5% fail to thrive, and 3.6–30% have fecal incontinence. In constipated children, anatomic causes of obstruction should be excluded. Once the anatomy is confirmed normal, laxatives, fiber, stool softeners, or mechanical management can be utilized. Botulinum toxin injections should be performed in all patients with HD before age 5 because of the nonrelaxing sphincters that they learn to overcome with increased age. Children with a patulous anus due to iatrogenic damage of the anal sphincters can be offered sphincter reconstruction. Hypermotility is managed with antidiarrheals and small-volume enemas. Family education is crucial in the early detection of HAEC and performing irrigations at home.
Conclusions: Recent updates in bowel management of HD patients focus on anatomic/pathology features of patients with HD, management of postoperative obstructive episodes, HAEC, soiling, and treatment of patients with total colonic Hirschsprung disease.
MeSH Keywords
bowel management/Hirschsprung disease/botox/enterocolitis/botulinum toxin/irrigation/obstruction/total colonic aganglionosis/fecal incontinence/enema/laxatives/constipation
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State-of-the-Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease
Background: The main goal of Hirschsprung disease (HD) surgery is to treat functional obstruction. Postoperative care involves continued good bowel emptying to achieve social continence. After an initial pull-through, patients with HD can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or soiling. The potential need for bowel management depends on the timing of the surgery, the length of the aganglionic segment, the technique, and the anatomic success of the pull-through.
Objectives/Goal: Our goal is to report updates on a bowel management program for patients with a colorectal diagnosis (anorectal malformation, Hirschsprung disease, spinal anomaly, and functional constipation) based on recent literature. As part of a manuscript series, this review is focused on the recent updates in evaluating and managing patients with HD.
Methods/Design: We performed a literature review using the Medline/PubMed database, focusing on published research papers over the last 5 years. Of the selected manuscripts and book chapters, 50 were included in this review. The search was performed using the following keywords: bowel management, Hirschsprung disease, botox, soiling, enterocolitis, HAEC, botulinum toxin, irrigations, obstruction, and total colonic.
Results: After the initial pull-though, 8–53.3% of patients experience obstructive symptoms, 25- 37% have HAEC, 7.5% fail to thrive, and 3.6–30% have fecal incontinence. In constipated children, anatomic causes of obstruction should be excluded. Once the anatomy is confirmed normal, laxatives, fiber, stool softeners, or mechanical management can be utilized. Botulinum toxin injections should be performed in all patients with HD before age 5 because of the nonrelaxing sphincters that they learn to overcome with increased age. Children with a patulous anus due to iatrogenic damage of the anal sphincters can be offered sphincter reconstruction. Hypermotility is managed with antidiarrheals and small-volume enemas. Family education is crucial in the early detection of HAEC and performing irrigations at home.
Conclusions: Recent updates in bowel management of HD patients focus on anatomic/pathology features of patients with HD, management of postoperative obstructive episodes, HAEC, soiling, and treatment of patients with total colonic Hirschsprung disease.
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