WOFAPS 2025 8th World Congress of Pediatric Surgery

Domingas Atouguia, Manuel Ramalhete, Tiago Tuna, Miguel Campos

Centro Hospitalar Universitário São João, Porto, Portugal

Introduction

Hirschsprung’s disease (HD) is a rare congenital pathology characterized by the absence of ganglion cells in the distal colon leading to functional bowel obstruction. The primary treatment for Hirschsprung's disease is surgical and the most common are anastomotic leakage and bowel obstruction. We present a rare case of post-operative bowel obstruction.

Case presentation

A 4-year-old male with a history of HD, diagnosed in the neonatal period following sub-occlusive episode, underwent a colonic pull-through using the De La Torre technique at 4 months old. After the surgery he was unable to pass stool and therefore an anastomosis stenosis was assumed. Following an unsuccessful anal dilatation program, he continued to require daily enemas. At that time, the parents looked for an appointment at our hospital. During the pre-operative evaluation, a rectoscopy revealed a stenosis 2-centimeter above the pectinate line with a "cork-like" appearance. The patient underwent a laparoscopic assisted reoperation, which confirmed the suspicion of a twist in the pulled-through segment. This twisted segment was resected, and a new pull-through was performed without complications. At the 7-month follow-up, the patient demonstrated a normal defecation pattern with no incontinence.

Conclusion

A twisted segment of a colonic pull-through is a rare complication following surgery for HD. Given the similarity in symptoms to more frequent causes of bowel obstruction after surgical correction, it is important to maintain a high index of suspicion for this condition. Timely diagnosis and surgical intervention, such as a re-do pull-through, are essential for resolving the twist and preventing further complications.