Primary swenson's pull-through in children with chronic constipation: a preliminary report

ABSTRACT

Background: The discrepancy in diameters of the resected ends coupled with the heavy faecal loads in the colon of chronically constipated children with Hirschsprung's disease makes definitive primary pull-through procedure quite difficulty in this group. Patients and Methods: Four consecutive patients (aged 5 months to 11 years) who presented with chronic constipation were given warm saline enema along with Castor oil per oram twice daily for 1 week before and 2 weeks after full-thickness biopsies that confirmed Hirschsprung's disease. All patients had intravenous Cefuroxime or Ceftriaxone plus Metronidazole at induction of anaesthesia. Intra-operatively; the levels of resections were 6-8 cm proximal to the most contractile part of the colon adjacent to the transition zone observed after complete division of mesenteric vessels. Results: There were three males and one female; aged 5 months to 11 years. The levels of aganglionosis were in the rectosigmoid region; except one in the descending colon. There was one case each of anastomotic stenoses; mild enterocolitis and deep peri-anal excoriation. The bowel motions were two to four times daily within 1 month post-operatively. Conclusion: It can be concluded from this preliminary study that with pre-operative saline enema and oral Castor oil for about 3 weeks in chronically constipated children with Hirschsprung's disease primary pull-through procedures can be performed successfully. However; further prospective work is required with this method: