Laparoscopic Management of Intestinal Obstruction due to a Tight Muscular Cuff Following Transanal Endorectal Pull-through for Hirschsprung's Disease

J Coll Physicians Surg Pak. 2022 Aug;32(8):S177-S179. doi: 10.29271/jcpsp.2022.Supp2.S177.

Abstract

Complications of Hirschsprung's disease's surgery include the general complications of any abdominal surgery, but one of the specific complications is obstruction, which occurs in 10% of children after surgical correction and can be due to a narrowing muscular cuff or a coloanal anastomotic stenosis. We report a case of a 4-month baby, diagnosed as suffering from Hirschsprung's disease, who developed postoperative constipation after transanal endorectal pull-through due to unusual folding of the muscular cuff, which narrowed the colon. A laparoscopic approach was performed. During the surgery, it was observed that the muscular cuff was rolled down, surrounding the neorectum. The anterior rectal cuff was completely divided from the pulled-through colon. After surgery, no intraluminal stenosis was revealed on digital rectal examination. A long and tight rectal muscular cuff could be the reason for postoperative obstructive side effects. The use of laparoscopy has the advantage of confirming the suspected diagnosis and a clear visualisation of the rectal cuff. Key Words: Hirschsprung disease, Intestinal obstruction, Laparoscopy.

Publication types

  • Case Reports

MeSH terms

  • Child
  • Constriction, Pathologic / surgery
  • Digestive System Surgical Procedures* / adverse effects
  • Hirschsprung Disease* / complications
  • Hirschsprung Disease* / surgery
  • Humans
  • Infant
  • Intestinal Obstruction* / etiology
  • Intestinal Obstruction* / surgery
  • Laparoscopy* / adverse effects
  • Postoperative Complications / etiology