Hirschsprung's Disease Case Study

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Discussion
Swenson's operation provides surgeons with a satisfactory method to treat Hirschsprung’s disease, some considered this a technically demanding surgery and the results were not quite as good in other people's hands [9]. Swenson's operation may be associated with injury of deep pelvic nerves, vessels and other structures such as vagina, prostate, vas deferens and seminal vesicles if dissection is not intimately done on the rectal wall [10].
To avoid such complications, many procedures were developed. Duhamel performed a retro rectal trans-anal pull-through to treat Hirschsprung’s disease [2]. This concept was developed to preserve the nerves to the bladder and nerve erigente and left the aganglionic rectum in place. The normally innervated
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Despite the etiology of enterocolitis is still unknown, several factors have been proposed as causative agents including mechanical dilation and fecal stasis [20], alteration in mucin components[21-23], infection with Clostredium Defficile[24,25] and Rota virus [26] and defect in mucosal defense mechanism[27-29].
The incidence of enterocolitis after Swenson's operation is 11.5-33.7 % [30-33]. In our series 4 (16%) patients developed enterocolitis. Out of the 4 patients, one had stricture on digital rectal examination and did not follow the postoperative irrigation and dilatation regimens, but reviewing his own post operative pathological results revealed that a normally ganglionated bowel with absence of hypertrophied nerve fibers had been pulled through. This patient required hospitalization for 3 days and received intravenous fluids and antibiotics ( ceftriaxone and metronidazole) and rectal irrigations, the other 3 patients had no stricture or residual aganglionosis and followed the post operative irrigation and dilatation regimens, those patients responded to medical treatment at home in the form of rectal irrigations and oral
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We think that the transanal Swenson approach which leaves no mechanical obstructive factors like muscular cuff as in Soave's procedure or aganglionic anterior rectal wall as in Duhamel's procedure if combined with postoperative irrigation regimen will significantly decrease the incidence of postoperative Hirschsprung associated enterocolitis. This is comparable to what reported by Marty et al who emphasized the importance of postoperative rectal irrigation. Marty found that enterocolitis developed in 3 of 40 patients who underwent 2 rectal irrigations after surgical treatment of Hirschsprung’s disease, while enterocolitis occurred in 34 of 95 patients who did not undergo to postoperative irrigation

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