performed conventionally with a laparotomy,or using laparoscopic techniques. In cases
of rectosigmoid Hirschprung, a wholly transanal approach can be used.
Total colonic aganglionosis w/small bowel involvement should be treated with
ileostomy initially. Any patient with ileostomy has sodium loss. Check urine sodium.
Patient may require oral sodium supplements to gain weight.
Complications
Hirschprung Associated Enterocolitis: Some babies may present initially with
enterocolitis if the diagnosis of HD is missed within the first few day of life. These
babies present with dehydration, lethargy, and distended abdomens. Other symptoms
may include refusal to eat, fevers, and vomiting, In the newborns, enterocolitis, is
associated with no stool output. It is important to note that enterocolitis can be seen in
patients who has had the definitive operation for Hirschprung. The presentation is the
same as that of a newborn.
A digital rectal examination elicits a forceful evacuation of stool. Abdominal Xray
would show intestinal distention and/or air-fluid levels.
HIRSCHPRUNG ASSOCIATED ENTEROCOLITIS CAN BE A LIFE-
THREATENING EVENT. When stool is not evacuated from the patient’s colon, enteric
bacteria multiply under pressure within the intestine. Clostridium difficile can be seen in
this setting. The patient can present in septic shock. The patient should be
resuscitated. IV antibiotics should be administered (must cover enteric flora). The