Damaged anal canal as a cause of fecal incontinence after surgical repair for Hirschsprung disease - a preventable and under-reported complication.
BACKGROUND
Fecal incontinence after the surgical repair of Hirschsprung disease is a potentially preventable complication that carries a negative impact on patient's quality of life.


METHODS
Patients that were previously operated for Hirschsprung disease and presented to our bowel management clinic with the complaint of fecal incontinence were retrospectively reviewed. All patients underwent a rectal examination under anesthesia looking for anatomic explanations for their incontinence.


RESULTS
One hundred three patients were identified. 54 patients had a damaged anal canal. 22 patients also had a patulous anus. The operative reports mentioned the pectinate line in 32 patients, in 12 it was not mentioned, and in 10 patients the operative report was not available. All patients with a damaged anal canal suffered from true fecal incontinence; 45 of them are on daily enemas (41 are clean and 4 are still having "accidents"), 7 are not doing bowel management due to noncompliance and 2 patients have a permanent ileostomy. 49 patients did not have a damaged anal canal, 25 of those responded to changes in diet and medication and are having voluntary bowel movements.


CONCLUSIONS
Fecal incontinence may occur after an operation for Hirschsprung disease. When the anal canal is damaged, incontinence is always present, severe, and probably permanent. The preservation of the anal canal may avoid this complication.
International Center for Colorectal Care, Children's Hospital Colorado, Aurora, CO, USA. Electronic address: andrea.bischoff@childrenscolorado.org.
Andrea
A
Bischoff
Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Jason
J
Frischer
Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Jennifer Leslie
JL
Knod
Colorectal and Complex Pelvic Malformation Center, Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
Belinda
B
Dickie
Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA.
Marc A
MA
Levitt
Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Monica
M
Holder
Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Lyndsey
L
Jackson
International Center for Colorectal Care, Children's Hospital Colorado, Aurora, CO, USA.
Alberto
A
Peña
D001003:Anal Canal / Q000293:injuries* / Q000601:surgery; D002648:Child; D004733:Enema; D005242:Fecal Incontinence / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006627:Hirschsprung Disease / Q000601:surgery* / Q000628:therapy; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies
Damaged anal canal; Fecal incontinence; Hirschsprung; Soiling