Hirschsprung disease

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[size=20px]A two year old child is admitted to the hospital for enterocolitis. At seven days of age he underwent a laparoscopic-assisted pull-through procedure for Hirschsprung disease with a transition zone identified by frozen section at the rectosigmoid junction. He has undergone intermittent treatment with anal Botox injections, oral metronidazole and home bowel washouts. A contrast enema done two weeks prior to this admission appeared normal. He has been admitted four times during the last six months. After stabilizing the patient, what is the best next step in his management? A diverting colostomy B change antibiotics C rectal dilations D appendicosto…

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[size=20px]You are asked to see a 3 year-old boy with obstructive symptoms following laparoscopic transanal Swenson pullthrough for Hirschsprung disease in the neonatal period. Digital rectal examination reveals a widely patent anastomosis. Contrast enema is normal without signs of megacolon. The next best step in the workup and management of this patient is:​ A Anorectal manometry B Colonic manometry C Botox injection of the internal anal sphincter D Rectal biopsy E Bowel management program[/size]

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