Abstract
In this chapter, the bowel management for the treatment of constipation and fecal incontinence after an operation for Hirschsprung’s disease is discussed.
For patients presenting with constipation, it is important to first rule out anatomic explanations such as stricture at the anastomosis site, twisted pull-through, a Duhamel operation, and a histologic error resulting in the pull-through of aganglionic segment. Once these conditions have been excluded, and the anal canal is found to be intact, the treatment consists in trying to determine the amount of laxative needed to empty the colon, radiologically demonstrated.
The most common cause of fecal incontinence following a pull-through for Hirschsprung’s disease is a damaged anal canal. These patients need to be managed with enemas. For patients with fecal incontinence and tendency to constipation, the enema should be with large volume and concentrated. For patients with fecal incontinence and tendency to diarrhea a small volume of normal saline enema, loperamide, and constipating diet is usually the treatment to keep them artificially clean for stool in the underwear.
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Bischoff, A., Peña, A. (2019). Bowel Management for the Treatment of Chronic Constipation and Soiling in Patients Operated for Hirschsprung’s Disease. In: Puri, P. (eds) Hirschsprung's Disease and Allied Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-15647-3_28
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DOI: https://doi.org/10.1007/978-3-030-15647-3_28
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