Hirschsprung's disease presenting beyond infancy: surgical options and postoperative outcome.
BACKGROUND
Hirschsprung's disease (HD) presenting late is not unusual in developing nations.


OBJECTIVE
To study surgical procedures and postoperative outcome in Hirschsprung's disease (HD) presenting after infancy.


METHODS
Records of 112 cases of confirmed HD who presented after infancy were analyzed for clinical presentations, investigations, surgical procedures and postoperative outcome. A Boley Scot pull through procedure was performed in all with or without a preliminary transverse colostomy.


RESULTS
The ages varied from 1 to 35 years. The rectosigmoid region was involved in all. Five cases presented with enterocolitis. Open biopsy and a diverting colostomy was performed in 91 cases (82%) with a colotomy in 4 for removal of fecalomas due to bowel dilatation on Barium study. This was followed by Boley Scot abdominal perineal pull through in 80 and Classical Soave in 11. Only 21 cases (18%) underwent single-stage endorectal pull through. Postoperative complications were encountered in 11/112 (9.8%).


CONCLUSIONS
82% children with HD presenting late required staged procedures due to dilated bowel. Single-stage pull through was feasible only in 18% cases. The postoperative complications were uncommon and managed successfully.
Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
Shilpa
S
Sharma
Devendra K
DK
Gupta
D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000503:physiopathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008365:Manometry; D011184:Postoperative Period; D011312:Pressure; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult