Care Following a Pull-Through Procedure for a Child with Hirschsprung Disease
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Hirschsprung disease affects the large intestine or colon and is characterized by the absence of ganglion cells (nerve cells) in part of the intestines.
Without ganglion cells, it is difficult for stool to pass through the colon and out of the anus.
Children with Hirschsprung disease have difficulty relaxing their anal sphincters, making it hard for them to stool.
Hirschsprung disease is treated with surgery to remove the segment of colon that does not have ganglion cells.
In pull-through surgery, the good bowel with ganglion cells is pulled down and connected to the rectum to help the child have more normal stooling.
No medical supplies are required to care for surgical sites after pull-through surgery.
Stitches on the child's bottom should be kept clean and dry.
Steri-strips (white strips of tape) covering abdominal incisions will fall off on their own in 7 to 14 days.
Steri-strips should not be pulled or removed, even if they look dirty or curl up on the ends, as removing them too soon can cause the skin to break open.
Children with an ostomy should return to their pre-surgery ostomy care routine.
Children stooling from their anus after surgery need special attention for their skin, as detailed in a separate skincare educational video.
After pull-through surgery, stool patterns may change during healing, ranging from very loose and watery several times a day to very thick and infrequent.
Children may be prescribed MiraLax and/or Senna upon discharge to ensure daily stooling.
MiraLax and Senna help soften stool so hard stool does not pass through the child's new anal opening.
For breastfed children stooling well, MiraLax and Senna may not be started until they begin eating solids and their stool starts to thicken.
Children stooling very often who are expected to have a fast-moving colon may be prescribed a diet and medications to slow down their stools.
Diet plays a major role in bowel management after pull-through surgery.
Laxative foods help stool be softer and looser.
Constipating foods help stool be thicker and harder.
Fever of 101°F or higher requires immediate contact with the medical team.
Yellow or green liquid or drainage from the incision requires immediate contact with the medical team.
Incision edges pulling open requires immediate contact with the medical team.
Catheter displacement (coming out of the child) requires immediate contact with the medical team.
Vomiting with inability to eat food or drink liquids requires immediate contact with the medical team.
Not stooling or stooling more than instructed requires immediate contact with the medical team.
Any signs of enterocolitis require immediate contact with the medical team.