PMC7652998_01
PMC7652998_02
Case 1 clinical course.
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Colon-in-loop (CIL) examination showed short segment Hirschsprung disease (Fig. 1a). The patient underwent Hartmann procedure and biopsy (Fig. 1b). Six months after colostomy, the patient was readmitted for stoma reversal and coloanal pull- through (Fig. 1c). Two weeks later, the patient was readmitted to undergo coloanal stump removal (Fig. 1d). The patient showed normal function of the intestinal tract after 2 years of follow-up and the anus looked normal (Fig. 1e).
PMC7652998_03
Case 2 clinical course.
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CIL examination showed short segment Hirschsprung disease (Fig. 2a). The patient underwent sigmoid colostomy and biopsy (Fig. 2b). Eight months after colostomy, the patient was readmitted for stoma reversal and coloanal pull- through (Fig. 2c). The patient was treated in the hospital for 10 days after the two procedures before she underwent coloanal stump removal (Fig. 2d). The patient showed normal function of the intestinal tract after 3 years of follow-up and the anus looked normal (Fig. 2e).
PMC7652998_04
Case 3 clinical course.
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CIL examination showed short segment Hirschsprung disease (Fig. 3a). The patient underwent sigmoid colostomy and biopsy (Fig. 3b). Five months after colostomy, the patient was readmitted for stoma reversal and coloanal pull- through (Fig. 3c). The patient was treated in the hospital for 11 days after the two procedures before she underwent coloanal stump removal (Fig. 3d). The patient showed normal function of the intestinal tract after 3 months of follow-up and the anus looked normal (Fig. 3e).
Surgical procedure of Modified Duhamel with stump coloanal and lateral anal sphincterotomy for adult Hirschsprung's disease.
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Transanal excision was done to the rectum with diameter 2 times the pulled-through intestine diameter (a c) (Fig. 4a). The intestine was pulled until at least 10 cm outside the anal canal to prevent retraction (d) (Fig. 4b).