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Poster Display - 97
Swenson-like pull-through for treatment of the rare association between Hirschsprung’s disease and anorectal malformation
mohamed Abdelmalak, Yasmine Ghazaly, Mosatafa zain, Saber Waheeb
1 Nile of Hope Hospital for Congenital Anomalies, Alexandria, Egypt
Abstract
Background Anorectal malformations and Hirschsprung’s disease are congenital conditions impacting the digestive
system, with a particularly uncommon co-occurrence, estimated at 2–3% of all ARM cases. This case series explores
this rare association through three distinct cases, each presenting unique clinical challenges and insights.
Methods We report a series of fve patients with ARM who were concurrently diagnosed with HD based on clini
cal and radiological evaluations, with defnitive confrmation obtained through rectal biopsy. In cases where HD
was diagnosed after the complete surgical repair of ARM, the patients underwent a Swenson-like pull-through pro
cedure. Notably, the anastomosis was created approximately 3 cm from the anal verge, rather than the conventional
3 cm from the dentate line.
Results This study reviewed the records of 136 ARM patients treated at our center over fve years, identifying fve
cases with concurrent HD. In three of these cases, HD was initially overlooked and diagnosed only after ARM repair.
These patients underwent a Swenson-like pull-through procedure. During follow-up, two patients achieved good
bowel control without fecal soiling, while the third had regular bowel movements and satisfactory growth, albeit
with occasional episodes of enterocolitis managed medically. The remaining two cases were identifed earlier, follow
ing colostomy, which led to a diferent management approach.
Conclusion This case series underscores the critical importance of considering HD in patients with ARM who present
with persistent, atypical gastrointestinal symptoms post-surgical repair of their ARM. Preservation of the agangli
onic neoanal canal with a subsequent Swenson pull-through appeared benefcial to achieve good postoperative
continence.
Keywords Swenson-like Pull-through, Hirschsprung’s Disease, Anorectal Malformation, Colorectal surgery