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 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.

Automated summary

This review focuses on the evaluation and treatment algorithms for children with Hirschsprung disease (HD), including common obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, and fecal soiling. It emphasizes the importance of excluding anatomical causes of obstruction and offers various management options, such as laxatives, fiber, osmotic laxatives, mechanical management, botulinum toxin injections, and sphincter reconstruction. The management of hypermotility involves antidiarrheals and small-volume enemas, and family education is crucial for the early detection of HAEC and performing at-home rectal irrigations.