First one with correct answer with justification win.

 

[size=20px]A two-year old male presents with refractory constipation following an uncomplicated Soave endorectal pull through for Hirschsprung disease.

 

The most likely indication for a redo pull through operation is

 

A anastomotic stricture.

 

B motility disorder.

 

C twisted pull through.

 

D tight muscular cuff.

 

E aganglionosis.[/size]

D

Think again my friend

C

think again my friend

A

Think again my dear

(Untitled)

 

E

E

correct

 

Successful surgical correction of Hirschsprung disease involves removal of the aganglionic bowel and restoration of gastrointestinal continuity using proximal normally innervated bowel. Postoperative difficulties may include constipation, soiling or enterocolitis. In the absence of obstruction these symptoms usually resolve. However, ongoing difficulties require further work up including rectal exam, contrast enema and rectal biopsy.

 

Although all of the above can be responsible for refractory obstruction, the most common indication for a redo pull through is residual aganglionosis. Possibilities include initial pathologist error, use of transition zone segment for the pull through or acquired aganglionosis due to loss of ganglion cells. It is essential that an experienced pathologist examine the entire circumference at the initial pull through for both ganglion cells and hypertrophic nerves to minimize this complication.