State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease

After an initial pull-though, patients with Hirschsprung disease (HD) can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or fecal soiling. This current review focuses on algorithms for evaluation and treatment in children with HD as a part of a ma...

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Published inChildren (Basel) Vol. 10; no. 8; p. 1418
Main Authors Bokova, Elizaveta, Prasade, Ninad, Janumpally, Sanjana, Rosen, John M, Lim, Irene Isabel P, Levitt, Marc A, Rentea, Rebecca M
Format Journal Article
LanguageEnglish
Published Basel MDPI AG 01.08.2023
MDPI
Subjects
Anxiety
Biopsy
botox
Botulinum toxin
bowel management
Care and treatment
Caregivers
Children & youth
Colon
Constipation
enterocolitis
Families & family life
Fecal incontinence
Feces
Gastrointestinal agents
Hirschsprung disease
Hirschsprung's disease
irrigation
Laxatives
Patients
Pediatrics
Psychological aspects
Quality of life
Review
Surgery
Toilet training
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Abstract After an initial pull-though, patients with Hirschsprung disease (HD) can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or fecal soiling. This current review focuses on algorithms for evaluation and treatment in children with HD as a part of a manuscript series on updates in bowel management. In constipated patients, anatomic causes of obstruction should be excluded. Once anatomy is confirmed to be normal, laxatives, fiber, osmotic laxatives, or mechanical management can be utilized. Botulinum toxin injections are performed in all patients with HD before age five 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 are offered sphincter reconstruction. Hypermotility is managed with antidiarrheals and small-volume enemas. Family education is crucial for the early detection of HAEC and for performing at-home rectal irrigations.
AbstractList After an initial pull-though, patients with Hirschsprung disease (HD) can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or fecal soiling. This current review focuses on algorithms for evaluation and treatment in children with HD as a part of a manuscript series on updates in bowel management. In constipated patients, anatomic causes of obstruction should be excluded. Once anatomy is confirmed to be normal, laxatives, fiber, osmotic laxatives, or mechanical management can be utilized. Botulinum toxin injections are performed in all patients with HD before age five 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 are offered sphincter reconstruction. Hypermotility is managed with antidiarrheals and small-volume enemas. Family education is crucial for the early detection of HAEC and for performing at-home rectal irrigations.
Audience Academic
Author Rosen, John M
Rentea, Rebecca M
Prasade, Ninad
Lim, Irene Isabel P
Levitt, Marc A
Bokova, Elizaveta
Janumpally, Sanjana
AuthorAffiliation 4 Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
1 Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
3 Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO 64108, USA
2 Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
5 Division of Colorectal and Pelvic Reconstruction, Children’s National Medical Center, Washington, DC 20001, USA
AuthorAffiliation_xml – name: 2 Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
– name: 1 Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
– name: 4 Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
– name: 3 Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO 64108, USA
– name: 5 Division of Colorectal and Pelvic Reconstruction, Children’s National Medical Center, Washington, DC 20001, USA
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CitedBy_id crossref_primary_10_3390_children11050570
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Snippet After an initial pull-though, patients with Hirschsprung disease (HD) can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC),...
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SubjectTerms Anxiety
Biopsy
botox
Botulinum toxin
bowel management
Care and treatment
Caregivers
Children & youth
Colon
Constipation
enterocolitis
Families & family life
Fecal incontinence
Feces
Gastrointestinal agents
Hirschsprung disease
Hirschsprung's disease
irrigation
Laxatives
Patients
Pediatrics
Psychological aspects
Quality of life
Review
Surgery
Toilet training
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Title State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease
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