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postoperative Hirschsprung patient with constipation

Ahmed Nabil1794482713
in Hirschsprung disease

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First one with correct answer with justification win.

 

[size=20px]A four-year old boy had a endorectal pull through for Hirschsprung disease as an infant. Since toilet training he has experienced increasing constipation with occasional encopresis. There is no stricture on exam or contrast enema, a repeat rectal biopsy shows ganglion cells are present and anorectal manometry reveals increased resting anal sphincter tone. Which of the following is the preferred next step in management of this Hirschsprung patient with constipation?

 

A antegrade continent enema procedure

 

B lateral internal sphincterotomy

 

C redo pull through

 

D biofeedback training

 

E ultrasound-guided intrasphincteric botulinum toxin injection[/size]

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