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...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-08-01
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| Series: | Children |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2227-9067/10/8/1418 |
| _version_ | 1797585102996242432 |
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| author | Elizaveta Bokova Ninad Prasade Sanjana Janumpally John M. Rosen Irene Isabel P. Lim Marc A. Levitt Rebecca M. Rentea |
| author_facet | Elizaveta Bokova Ninad Prasade Sanjana Janumpally John M. Rosen Irene Isabel P. Lim Marc A. Levitt Rebecca M. Rentea |
| author_sort | Elizaveta Bokova |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-11T00:02:06Z |
| format | Article |
| id | doaj.art-4492ecc3728d4adf83fd0a347948704a |
| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-11T00:02:06Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj.art-4492ecc3728d4adf83fd0a347948704a2023-11-19T00:41:20ZengMDPI AGChildren2227-90672023-08-01108141810.3390/children10081418State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung DiseaseElizaveta Bokova0Ninad Prasade1Sanjana Janumpally2John M. Rosen3Irene Isabel P. Lim4Marc A. Levitt5Rebecca M. Rentea6Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Kansas City, Kansas City, MO 64108, USAComprehensive Colorectal Center, Department of Surgery, Children’s Mercy Kansas City, Kansas City, MO 64108, USAComprehensive Colorectal Center, Department of Surgery, Children’s Mercy Kansas City, Kansas City, MO 64108, USADivision of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Mercy Kansas City, Kansas City, MO 64108, USAComprehensive Colorectal Center, Department of Surgery, Children’s Mercy Kansas City, Kansas City, MO 64108, USADivision of Colorectal and Pelvic Reconstruction, Children’s National Medical Center, Washington, DC 20001, USAComprehensive Colorectal Center, Department of Surgery, Children’s Mercy Kansas City, Kansas City, MO 64108, USAAfter 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.https://www.mdpi.com/2227-9067/10/8/1418bowel managementHirschsprung diseasebotoxenterocolitisbotulinum toxinirrigation |
| spellingShingle | Elizaveta Bokova Ninad Prasade Sanjana Janumpally John M. Rosen Irene Isabel P. Lim Marc A. Levitt Rebecca M. Rentea State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease Children bowel management Hirschsprung disease botox enterocolitis botulinum toxin irrigation |
| title | State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease |
| title_full | State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease |
| title_fullStr | State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease |
| title_full_unstemmed | State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease |
| title_short | State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease |
| title_sort | state of the art bowel management for pediatric colorectal problems hirschsprung disease |
| topic | bowel management Hirschsprung disease botox enterocolitis botulinum toxin irrigation |
| url | https://www.mdpi.com/2227-9067/10/8/1418 |
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