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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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Autores principales: Bokova, Elizaveta, Prasade, Ninad, Janumpally, Sanjana, Rosen, John M., Lim, Irene Isabel P., Levitt, Marc A., Rentea, Rebecca M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10453740/
https://www.ncbi.nlm.nih.gov/pubmed/37628417
http://dx.doi.org/10.3390/children10081418
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author Bokova, Elizaveta
Prasade, Ninad
Janumpally, Sanjana
Rosen, John M.
Lim, Irene Isabel P.
Levitt, Marc A.
Rentea, Rebecca M.
author_facet Bokova, Elizaveta
Prasade, Ninad
Janumpally, Sanjana
Rosen, John M.
Lim, Irene Isabel P.
Levitt, Marc A.
Rentea, Rebecca M.
author_sort Bokova, Elizaveta
collection PubMed
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.
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spelling pubmed-104537402023-08-26 State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease Bokova, Elizaveta Prasade, Ninad Janumpally, Sanjana Rosen, John M. Lim, Irene Isabel P. Levitt, Marc A. Rentea, Rebecca M. Children (Basel) Review 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. MDPI 2023-08-20 /pmc/articles/PMC10453740/ /pubmed/37628417 http://dx.doi.org/10.3390/children10081418 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Bokova, Elizaveta
Prasade, Ninad
Janumpally, Sanjana
Rosen, John M.
Lim, Irene Isabel P.
Levitt, Marc A.
Rentea, Rebecca M.
State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease
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 Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10453740/
https://www.ncbi.nlm.nih.gov/pubmed/37628417
http://dx.doi.org/10.3390/children10081418
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