# Hirschsprung's-associated Enterocolitis — GCMD Library living collection

Everything in the library about Hirschsprung-associated enterocolitis — built automatically from dossiers that name it.

Updated: n/a · 5 episodes · 82 cited statements

## Episodes
### Acute Management
- [Suspected Hirschsprung's-associated enterocolitis (HAEC) Treatment Guideline...](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540) — video · [machine version](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540.md)

### Medical Management
- [Update Course Rewind: Botox in Hirschsprung Disease 2023](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941) — video · 5:55 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941.md)

### Case-Based Learning
- [Colorectal Quiz Episode 19: Hirschsprung Disease - The Obstructed Patient Part 1](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407) — podcast · 24:11 · [machine version](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407.md)
- [The Colorectal Quiz Episode 20: Hirschsprung Disease Obstruction Part 2](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461) — podcast · 21:29 · [machine version](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461.md)

### Long-Term Care
- [Evaluation and Management of Postsurgical Patient With Hirschsprung Disease Neurogastroenterology & Motility Committee: Position Paper of North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN)](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989) — podcast · 17:08 · [machine version](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=0) Introduction (Ep 1)
- [0:21](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=21) Background and Patient Population (Ep 1)
- [2:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=120) Eight Key Steps of the Guideline (Ep 1)
- [5:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=300) Post-Admission Management and Summary (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=0) Case Introduction: 7-Year-Old with Post-Pull-Through Obstruction (Ep 2)
- [2:20](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=140) Differential Diagnosis of Post-Pull-Through Obstruction (Ep 2)
- [6:41](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=401) Hirschsprung-Associated Enterocolitis: Recognition and Management (Ep 2)
- [11:41](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=701) Contrast Enema Interpretation and Surgical Planning (Ep 2)
- [22:09](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=1329) Episode Summary and Preview (Ep 2)
- [0:05](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=5) Case Introduction and Exam Under Anesthesia Overview (Ep 3)
- [1:32](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=92) Systematic Exam Under Anesthesia Technique (Ep 3)
- [5:22](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=322) Case Findings and Imaging Interpretation (Ep 3)
- [8:00](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=480) Repeat Biopsy Interpretation and Pathological Considerations (Ep 3)
- [14:31](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=871) Case Resolution and Surgical Approach (Ep 3)
- [17:21](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=1041) Summary and Key Teaching Points (Ep 3)
- [0:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=0) Introduction and Clinical Scenario (Ep 4)
- [1:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=68) Pathophysiology and Botox Technique (Ep 4)
- [1:59](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=119) Mechanisms of Enterocolitis (Ep 4)
- [3:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=215) Evidence for Botox Use (Ep 4)
- [4:47](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=287) Summary and Conclusion (Ep 4)
- [0:00](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=0) Introduction: Long-term complications of Hirschsprung disease and the need for systematic management (Ep 5)
- [3:41](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=221) Diagnostic approach: Ruling out anatomical and pathological causes before functional testing (Ep 5)
- [6:46](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=406) Functional testing: Anorectal and colonic manometry (Ep 5)
- [7:53](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=473) Management pathway A: Obstructive symptoms and treatment strategies (Ep 5)
- [10:01](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=601) Management pathway B: Fecal incontinence—distinguishing retentive from non-retentive types (Ep 5)
- [14:31](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=871) Advanced management for refractory fecal incontinence and closing reflections (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Papers by Pastor et al and Gosain et al outline frameworks and clinical guidelines for management of enterocolitis" — Meera Kotagal (guideline) [Ep 1 · 0:21](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=21)
- "The guideline is most appropriate for patients with either known or suspected Hirschsprung's who present with GI symptoms and/or fever" — Meera Kotagal (guideline) [Ep 1 · 0:21](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=21)
- "GI symptoms in HAEC include abdominal distension, vomiting, no or minimal stool, foul smelling stool, or explosive diarrhea" — Meera Kotagal (clinical) [Ep 1 · 0:21](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=21)
- "Systemic signs of concern include fever, lethargy, age-adjusted tachycardia, tachypnea, hypotension, or oliguria" — Meera Kotagal (clinical) [Ep 1 · 0:21](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=21)
- "Patients should be seen and evaluated as soon as possible, ideally within one hour by someone with clinical expertise such as a surgical fellow or attending" — Meera Kotagal (guideline) [Ep 1 · 2:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=120)
- "The exam should include a rectal exam" — Meera Kotagal (guideline) [Ep 1 · 2:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=120)
- "If the patient is less than four weeks out from surgery, fellows should discuss the rectal exam with an attending surgeon prior to performing it" — Meera Kotagal (guideline) [Ep 1 · 2:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=120)
- "Irrigations should not be delayed for patients to get an x-ray" — Meera Kotagal (guideline) [Ep 1 · 2:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=120)
- "Irrigations should be repeated as frequently as every eight hours, but even every six or four hours as needed for sicker patients" — Meera Kotagal (guideline) [Ep 1 · 2:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=120)
- "Abdominal films should be obtained upon arrival and then repeated again after an irrigation to demonstrate adequate decompression" — Meera Kotagal (guideline) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=180)
- "Abdominal films can be repeated throughout the course of the hospitalization as clinically necessary" — Meera Kotagal (guideline) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=180)
- "Patients should be NPO and started on IV fluids to assist with resuscitation and hydration" — Meera Kotagal (guideline) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=180)
- "Patients without systemic signs who are mostly clinically well can be maintained on either IV or oral flagyl during hospitalization" — Meera Kotagal (guideline) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=180)
- "All patients who are vomiting should be on IV antibiotics" — Meera Kotagal (guideline) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=180)
- "Patients with systemic signs who are sicker need broad spectrum antibiotics, specifically Zosyn and flagyl at Cincinnati Children's" — Meera Kotagal (guideline) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=180)
- "All patients should get a CBC and a basic metabolic panel" — Meera Kotagal (guideline) [Ep 1 · 4:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=240)
- "A venous blood gas should be obtained for sicker patients to help evaluate resuscitation needs" — Meera Kotagal (guideline) [Ep 1 · 4:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=240)
- "Patients with systemic signs should be evaluated for potential admission to the ICU" — Meera Kotagal (guideline) [Ep 1 · 4:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=240)
- "After an admission for enterocolitis, patients are continued on metronidazole and irrigations for a few weeks and then slowly tapered" — Meera Kotagal (guideline) [Ep 1 · 5:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=300)
- "Underlying anatomic issues such as a stricture or a transition zone pull through must be addressed to prevent recurrent enterocolitis" — Meera Kotagal (clinical) [Ep 1 · 5:00](https://qa.library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=300)
- "Post-pull-through obstruction can be caused by stricture, twist (any pull-through type), Soave cuff (Soave procedure), Duhamel spur or non-functional distended segment (Duhamel procedure), or non-functional segment (Rehbein procedure)." — Hira Ahmad (clinical) [Ep 2 · 6:45](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=405)
- "In obstructed Hirschsprung patients, the colon fills with liquid stool with severe bacterial overgrowth, causing fluid loss into the bowel lumen, hypovolemia, and bacterial translocation/bacteremia, all occurring without passage of stool." — Marc Levitt (clinical) [Ep 2 · 10:10](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=610)
- "Enterocolitis can occur before surgery, after surgery, and even after successful surgery in babies who don't relax their sphincters and hold stool so efficiently they develop enterocolitis." — Marc Levitt (clinical) [Ep 2 · 11:06](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=666)
- "For a patient with prior Hirschsprung diagnosis presenting sick, assume Hirschsprung-associated enterocolitis; treatment with rectal irrigations, IV fluids, and antibiotics will not cause harm even if the diagnosis is different (e.g., Crohn's disease, E. coli enterocolitis)." — Jason Frischer (clinical) [Ep 2 · 12:06](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=726)
- "Post-pull-through enterocolitis within the first 3 months occurs in about 20% of patients, based on a study from Cincinnati and Columbus." — Marc Levitt (epidemiological) [Ep 2 · 13:58](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=838)
- "Families should not undergo Hirschsprung pull-through surgery until they can demonstrate ability to perform rectal irrigations, and they should be discharged with supplies to perform irrigations at home." — Jason Frischer (guideline) [Ep 2 · 14:58](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=898)
- "In rare circumstances where a patient is too ill and sedation in the ER doesn't work, go to the OR under general anesthesia for irrigation until the patient improves; occasionally an ileostomy is needed to get the child out of trouble and work up the pull-through problem later." — Marc Levitt (clinical) [Ep 2 · 16:30](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=990)
- "On contrast enema, it is important to look at the presacral space (space between the hollow of the sacrum and the pull-through); a widened presacral space is an abnormal finding." — Marc Levitt (clinical) [Ep 2 · 19:14](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=1154)
- "On contrast enema, if the catheter is inserted too high or the balloon is under too much pressure, distal pathology cannot be easily ascertained." — Rebecca Rentia (clinical) [Ep 2 · 20:48](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=1248)
- "A lateral view on contrast enema is important because it provides significant information about the presacral space and distal rectum anatomy." — Jason Frischer (clinical) [Ep 2 · 19:43](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=1183)
- "The anatomy of the original pull-through can explain the patient's obstructive symptoms, and it is important to know what pull-through type was performed to determine if there is a fixable problem." — Marc Levitt (clinical) [Ep 2 · 3:06](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=186)
- "If the original operative note is unavailable, a contrast study can help infer the original surgery type based on imaging findings; expertise in reading post-pull-through contrast studies is essential." — Marc Levitt (clinical) [Ep 2 · 7:42](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=462)
- "In a very ill child, a contrast study would not be the best initial option; resuscitation and stabilization should come first." — Rebecca Rentia (clinical) [Ep 2 · 8:25](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=505)
- "When performing initial rectal exam on a distended child with suspected enterocolitis, step to the side because there may be an explosive release of stool and gas." — Jason Frischer (clinical) [Ep 2 · 4:51](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=291)
- "In Hirschsprung patients with distention, irritability, and fever, enterocolitis should be assumed until proven otherwise." — Marc Levitt (clinical) [Ep 2 · 10:39](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=639)
- "Irrigation is the best way to break the cycle of enterocolitis because patients are not passing stool due to distal obstruction." — Marc Levitt (clinical) [Ep 2 · 10:55](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=655)
- "When reading literature on Hirschsprung enterocolitis rates, be aware that definitions vary (admission, need for irrigations, need for antibiotics); the PCPLC consortium is working on validating the Langer score for uniform application." — Marc Levitt (opinion) [Ep 2 · 13:31](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=811)
- "After pull-through surgery, wait one to two weeks before performing the first irrigation, and the first irrigation should be performed by someone who is confident and knows where the anastomosis is." — Marc Levitt (clinical) [Ep 2 · 14:31](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=871)
- "In a logical workup, obtain the contrast study before going to the OR for rectal exam under anesthesia, as it may reveal findings that guide the surgical approach." — Jason Frischer (clinical) [Ep 2 · 18:19](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-19-hirschsprung-disease-the-obstructed-patient-part-1-4407?t=1099)
- "For exam under anesthesia in Hirschsprung's patients, digital exam should assess for circumferential stricture at the anastomosis" — Hira Ahmad (clinical) [Ep 3 · 1:36](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=96)
- "Hagar dilator can be used to size the anastomotic opening to ensure adequate caliber" — Hira Ahmad (clinical) [Ep 3 · 1:57](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=117)
- "Foley catheter passage can determine if there is a twist in the pull-through segment" — Hira Ahmad (clinical) [Ep 3 · 2:04](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=124)
- "Swabe cuff presents as a 1-2 centimeter circumferential narrowing that is not the anastomosis itself" — Hira Ahmad (clinical) [Ep 3 · 2:23](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=143)
- "For patients with previous Duhamel procedure, full-thickness rectal biopsy should be performed posteriorly because that segment should be ganglionic" — Hira Ahmad (clinical) [Ep 3 · 2:33](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=153)
- "In Duhamel procedure, rectal exam should assess for two lumens and a spur between them, as stool can flow into the Duhamel pouch, fill it, and compress the ganglionated pull-through" — Marc Levitt (clinical) [Ep 3 · 3:00](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=180)
- "Treatment for problematic Duhamel spur is to take out the common wall; occasionally the Duhamel pouch itself needs excision" — Marc Levitt (clinical) [Ep 3 · 3:25](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=205)
- "Before anesthesia induction, it is important to examine the anus for sphincteric contraction vs. patulous appearance" — Marc Levitt (clinical) [Ep 3 · 3:36](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=216)
- "A patulous anus will not develop enterocolitis" — Marc Levitt (clinical) [Ep 3 · 3:48](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=228)
- "During exam and biopsy, close examination is needed to ensure the dentate line was preserved at the original pull-through" — Marc Levitt (clinical) [Ep 3 · 3:57](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=237)
- "If the dentate line has been lost at original pull-through or sphincters have been overstretched, the patient will not have enterocolitis but will have fecal incontinence" — Marc Levitt (clinical) [Ep 3 · 4:12](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=252)
- "Botox is being studied to prevent enterocolitis with the theory of chemo-denervating nerves in the area instead of permanent stretch or anatomic destruction from surgery" — Jason Frischer (clinical) [Ep 3 · 4:26](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=266)
- "Lone Star retractor should be used to obtain a circumferential view of the anastomotic area during exam under anesthesia" — Rebecca Rentia (clinical) [Ep 3 · 4:57](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=297)
- "To palpate for Swabe cuff, place finger against the sacrum and pull down to feel rubbery tissue outside the pull-through" — Marc Levitt (clinical) [Ep 3 · 14:08](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=848)
- "If repeat biopsy after pull-through shows no ganglion cells, it is very likely an aganglionotic or transition zone pull-through, though sampling error must be considered" — Marc Levitt (clinical) [Ep 3 · 8:08](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=488)
- "Ganglion cells with hypertrophic nerves on repeat biopsy is more controversial; some surgeons offer redo for significantly obstructive patients with this finding" — Marc Levitt (opinion) [Ep 3 · 8:33](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=513)
- "Hypertrophic nerves in the presence of ganglion cells can occur in functional constipation patients, and may develop in Hirschsprung's patients not emptying well due to sphincter dysfunction" — Marc Levitt (clinical) [Ep 3 · 8:52](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=532)
- "Until comparing original and repeat pathology, it is unclear whether hypertrophic nerves represent original pathology error or secondary changes that evolved over time" — Marc Levitt (clinical) [Ep 3 · 9:46](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=586)
- "The Swenson procedure was the first Hirschsprung's operation and is the purest, leaving the least amount of Hirschsprung's tissue behind" — Marc Levitt (clinical) [Ep 3 · 13:05](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=785)
- "The Swabe and Duhamel procedures were developed because surgeons were doing the Swenson in too wide a plane and injuring the nervi erigentes in the mesorectum" — Marc Levitt (clinical) [Ep 3 · 13:15](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=795)
- "If you stay right on the bowel wall during Swenson dissection, you avoid nerve injury" — Marc Levitt (clinical) [Ep 3 · 13:24](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=804)
- "In the original laparoscopic Swabe described by Keith Jorgeson, a 5 centimeter cuff was recommended, which is too long" — Marc Levitt (opinion) [Ep 3 · 12:40](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=760)
- "Many Swabe surgeons are now approaching a Swenson technique or have transitioned to Swenson, using a mini-cuff (approximately 1 centimeter)" — Marc Levitt (clinical) [Ep 3 · 12:30](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=750)
- "Sometimes the Swabe cuff fuses back together or is not cut all the way, creating an aganglionotic obstructive ring around the pull-through" — Marc Levitt (clinical) [Ep 3 · 13:45](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=825)
- "For redo pull-through in aganglionotic cases, the approach is total body prep, then transanal dissection in prone position first, going as far as possible; if healthy bowel cannot reach, be prepared for laparoscopy or laparotomy" — Marc Levitt (clinical) [Ep 3 · 15:54](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=954)
- "Redo pull-throughs are easier to perform in prone position" — Marc Levitt (opinion) [Ep 3 · 16:07](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=967)
- "Initial treatment for obstructed Hirschsprung's patient must include rectal irrigation, done early" — Jason Frischer (guideline) [Ep 3 · 17:23](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=1043)
- "Every institution should have a protocol for obstructed Hirschsprung's patients to ensure quick and efficient response" — Jason Frischer (guideline) [Ep 3 · 17:28](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=1048)
- "Systematic workup for obstructed Hirschsprung's includes: resuscitation, imaging studies, and comprehensive rectal exam under anesthesia" — Jason Frischer (guideline) [Ep 3 · 17:41](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=1061)
- "Gastroenterologists and surgeons must know the anatomy of the original pull-through procedure (Swabe, Swenson, or Duhamel) when evaluating obstructed patients" — Marc Levitt (guideline) [Ep 3 · 18:32](https://qa.library.globalcastmd.com/watch/the-colorectal-quiz-episode-20-hirschsprung-disease-obstruction-part-2-4461?t=1112)
- "Every baby with Hirschsprung disease has a poorly functioning sphincter by nature of the disease." — Caitlin Smith (clinical) [Ep 4 · 1:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=74)
- "Botox dosing varies widely in the literature: any amount of Botox in any aliquots in any number of locations." — Caitlin Smith (host_summary) [Ep 4 · 1:33](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=93)
- "Dr. Smith uses 100 units in 1 mL, usually 3-4 injections in the dentate line." — Caitlin Smith (clinical) [Ep 4 · 1:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=105)
- "Common practice is 100 units in 1 cc of saline, with ultrasound guidance optional based on preference." (clinical) [Ep 4 · 1:51](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=111)
- "No matter what operation is done for Hirschsprung's, ganglionic bowel is always left, at least the internal sphincter." — Steven Lee or Julia Grabowski (clinical) [Ep 4 · 2:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=120)
- "To maintain continence, the dentate line must be preserved, requiring a tiny bit of aganglionic internal sphincter to be left." — Caitlin Smith (clinical) [Ep 4 · 2:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=137)
- "Babies outgrow enterocolitis because their external sphincter becomes able to overcome their internal sphincter as their body matures." — Caitlin Smith (opinion) [Ep 4 · 2:23](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=143)
- "The actual pathophysiology of Hirschsprung-associated enterocolitis has not been pinpointed." — Caitlin Smith (clinical) [Ep 4 · 2:23](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=143)
- "Hirschsprung physiology causes the colon to act like a pond with poor emptying and motility issues, allowing bacterial overgrowth if the colon is not cleared diligently." (clinical) [Ep 4 · 2:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=157)
- "There is a significantly higher rate of enterocolitis in total colonic Hirschsprung disease after pull-through compared to shorter segment disease." — Caitlin Smith (epidemiological) [Ep 4 · 3:06](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=186)
- "Children with trisomy 21 have a much higher rate of enterocolitis in Hirschsprung disease." — Caitlin Smith (epidemiological) [Ep 4 · 3:21](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=201)
- "Enterocolitis can occur even when patients are doing rectal irrigations at home; sometimes it is not enough to empty the colon." — I'm Goddy (host_summary) [Ep 4 · 3:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=205)
- "There is discussion about whether colectomy should be performed at the time of total colon Hirschsprung diagnosis because of enterocolitis risk." — Caitlin Smith (clinical) [Ep 4 · 3:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=215)
- "Most studies on Botox in Hirschsprung disease are single institution retrospective studies." — I'm Goddy (host_summary) [Ep 4 · 3:44](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=224)
- "There is significant phenotypic variance in Hirschsprung disease, making study data imperfect." — Caitlin Smith (clinical) [Ep 4 · 3:49](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=229)
- "According to Dr. Smith, even prospective data will not be perfect because of patient variability, different surgical techniques, different disease levels, and different comorbidities and syndromes." — I'm Goddy (host_summary) [Ep 4 · 4:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=240)
- "Some data suggest prophylactic Botox has not been shown to decrease the risk of enterocolitis." — Caitlin Smith (host_summary) [Ep 4 · 4:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=253)
- "Botox has been shown to decrease the length of stay in patients admitted for enterocolitis." — Caitlin Smith (host_summary) [Ep 4 · 4:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=254)
- "Botox has been shown to potentially decrease hospitalizations in patients with recurrent episodes of obstruction or enterocolitis." — Caitlin Smith (host_summary) [Ep 4 · 4:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=266)
- "Not everyone may need Botox at the time of pull-through, but there may be a subset of patients with predisposition to enterocolitis who would benefit from Botox as part of treatment strategy." — Caitlin Smith (opinion) [Ep 4 · 4:34](https://qa.library.globalcastmd.com/watch/update-course-rewind-botox-in-hirschsprung-disease-2023-7941?t=274)
- "Hirschsprung disease fundamentally involves the absence of ganglion cells in a section of bowel, preventing that section from relaxing properly during peristalsis and causing functional blockage." (host_summary) [Ep 5 · 0:28](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=28)
- "The two major long-term issues affecting quality of life after Hirschsprung disease surgery are fecal incontinence and ongoing obstructive symptoms including persistent constipation and Hirschsprung-associated enterocolitis (HAEC)." (host_summary) [Ep 5 · 1:06](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=66)
- "Hirschsprung-associated enterocolitis (HAEC) occurs in 25% to 37% of patients after surgery and carries a mortality risk of up to 10%." (host_summary) [Ep 5 · 1:58](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=118)
- "Post-operative constipation rates in Hirschsprung disease patients range from 6% to 40% in the literature." (host_summary) [Ep 5 · 2:21](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=141)
- "Fecal incontinence rates in post-surgical Hirschsprung disease patients range from 8% to 74% in the literature." (host_summary) [Ep 5 · 2:24](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=144)
- "Studies show Hirschsprung disease patients score lower in psychosocial quality of life compared to healthy children." (host_summary) [Ep 5 · 2:46](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=166)
- "Effective management of post-surgical Hirschsprung disease requires a multidisciplinary team including colorectal surgeon, neurogastroenterologist, dietitian, specialized nurses, social worker, and psychologist, following the patient into adulthood." (host_summary) [Ep 5 · 3:08](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=188)
- "Before functional testing in symptomatic post-surgical Hirschsprung patients, anatomical blockages and issues with the original surgery must be ruled out through detailed history, physical exam, growth assessment, pathology review, imaging, and examination under anesthesia." (host_summary) [Ep 5 · 3:54](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=234)
- "Original pathology slides from Hirschsprung surgery must be reviewed by an experienced pathologist to confirm there is no residual aganglionosis, transition zone pull-through, or skip areas; if slides are unavailable or unclear, rebiopsy is necessary." (host_summary) [Ep 5 · 4:19](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=259)
- "Mechanical obstructions after Hirschsprung surgery include anastomotic stricture (scar tissue narrowing the connection), kinking or twisting of pulled-through colon, tight muscle cuff in Soave procedures, residual spur in Duhamel procedures, or enlarged floppy pouch collecting stool." (host_summary) [Ep 5 · 5:38](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=338)
- "Anorectal manometry (ARM) measures pressures and reflexes in the rectum and anal canal, assessing both voluntary control and involuntary functions." (host_summary) [Ep 5 · 6:33](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=393)
- "In Hirschsprung disease patients, the internal anal sphincter often does not relax properly when the rectum fills with stool, resulting in absent recto-anal inhibitory reflex, which anorectal manometry can confirm by measuring sphincter pressures." (host_summary) [Ep 5 · 6:54](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=414)
- "Colonic manometry is reserved for patients with persistent, refractory symptoms after other diagnostic steps and initial therapies, and provides a map of colonic contractility patterns including coordination, strength, and transit speed." (host_summary) [Ep 5 · 7:27](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=447)
- "First-line treatment for functional obstruction in post-surgical Hirschsprung disease is daily stimulant laxatives (senosides or bisacodyl) dosed to achieve effective colonic emptying and decompression, which reduces HAEC risk." (host_summary) [Ep 5 · 8:11](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=491)
- "When anorectal manometry confirms high pressures in a hypertonic, non-relaxing internal anal sphincter, botulinum toxin injection directly into the sphincter muscle is the targeted treatment." (host_summary) [Ep 5 · 8:41](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=521)
- "Botulinum toxin injection is effective for obstructive symptoms in approximately 66% of Hirschsprung disease patients with hypertonic internal anal sphincter." (host_summary) [Ep 5 · 9:20](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=560)
- "Botulinum toxin effect on the internal anal sphincter is temporary, typically lasting around 6 months, requiring repeat injections, but is preferred over permanent surgical myectomy because myectomy carries real risk of causing permanent fecal incontinence." (host_summary) [Ep 5 · 9:32](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=572)
- "The critical first distinction in fecal incontinence management is determining whether it is retentive (overflow from severe constipation) or non-retentive (true sphincter or sensory dysfunction)." (host_summary) [Ep 5 · 10:11](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=611)
- "Retentive fecal incontinence is overflow incontinence where the patient is severely constipated and impacted, with liquid stool leaking around the blockage; the underlying problem is obstruction." (host_summary) [Ep 5 · 10:22](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=622)
- "Non-retentive fecal incontinence is true incontinence where the colon is relatively empty but the patient cannot hold stool back effectively due to sphincter mechanism or sensation problems." (host_summary) [Ep 5 · 10:38](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=638)
- "A radio-opaque marker study showing 5 or more markers remaining inside after 5 days points strongly towards significant retention, indicating retentive fecal incontinence." (host_summary) [Ep 5 · 10:52](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=652)
- "The dentate line deep in the anal canal is packed with sensory nerves that help discriminate between gas, liquid, or solid stool; if damaged or removed during pull-through surgery, patients lose this discriminatory ability leading to accidents." (host_summary) [Ep 5 · 11:36](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=696)
- "Initial conservative management for non-retentive fecal incontinence includes dietary changes (constipating diet), adding soluble fiber (pectin or psyllium) to absorb water and add bulk without loosening stool, and avoiding insoluble fiber which can worsen leakage." (host_summary) [Ep 5 · 12:13](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=733)
- "Timed toilet sitting after meals is recommended to harness the gastrocolonic reflex in a controlled way for managing non-retentive fecal incontinence." (host_summary) [Ep 5 · 12:40](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=760)
- "Anti-motility agents (loperamide, cholestyramine, hyoscyamine) are used to slow colonic transit and can help increase internal anal sphincter tone slightly in non-retentive fecal incontinence." (host_summary) [Ep 5 · 12:51](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=771)
- "In some non-retentive fecal incontinence patients, colonic manometry reveals dramatic colonic hyperactivity with powerful rapidly moving high amplitude propagating contractions (HAPCs) that blast stool through the pulled-through bowel and out the anus." (host_summary) [Ep 5 · 13:21](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=801)
- "The sigmoid colon normally acts as a storage area and brake, but is often removed or altered in pull-through surgery, eliminating the stopping point for colonic contractions." (host_summary) [Ep 5 · 13:53](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=833)
- "When colonic manometry confirms hyperactive colon with runaway contractions as the mechanism of non-retentive fecal incontinence, laxatives are contraindicated and targeted anti-motility agents to reduce HAPCs and slow the colon are the correct treatment." (host_summary) [Ep 5 · 14:07](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=847)
- "If non-retentive fecal incontinence persists despite optimized medical therapy, the next steps are structured emptying programs starting with low-volume retrograde enemas, then considering antegrade continence enemas (ACE)." (host_summary) [Ep 5 · 14:41](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=881)
- "In an ACE procedure, the surgeon creates a small channel (usually connecting the appendix or tube to the abdominal skin) allowing the patient or caregiver to administer enema fluid directly into the beginning of the colon each day, flushing everything out from above in a predictable way." (host_summary) [Ep 5 · 15:07](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=907)
- "Antegrade continence enemas (ACE) have success rates of 69% to 91% for improving continence and quality of life in refractory fecal incontinence." (host_summary) [Ep 5 · 15:26](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=926)
- "ACE is seen as the critical step before contemplating major resections or creating a permanent stoma (ostomy bag) for refractory fecal incontinence." (host_summary) [Ep 5 · 15:37](https://qa.library.globalcastmd.com/watch/evaluation-and-management-of-postsurgical-patient-with-hirschsprung-disease-neurogastroenterology-motility-committee-position-paper-of-north-american-society-of-pediatric-gastroenterology-hepatology-and-nutrition-13989?t=937)

## Changelog
- Sep 12: 1 item added automatically
- Sep 7: 4 items added automatically

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