A CASE OF REOPERATION FOR ADULT HIRSCHSPRUNG'S DISEASE

A 22-year-old male was admitted for reoperation for Hirschsprung's disease. He had already undergone surgical treatment six times previously, including radical treatment. However, severe constipation due to incomplete resection of the narrow segment had continued for 14 years. A barium enema disclosed enlarged sigmoid colon and apparent narrow segment, 8cm in length. The difficulties in this reoperation were as follows. 1) The normal colon was too short because the patient had twice undergone right transverse colostomy. 2) There was a risk of impairment of the marginal vascular supply, which would impair the pull-through colon. The following three operations were carried out. First a sigmoidostomy (stage 1) was performed. The descending colon returned to the normal caliber eight months later. Then a mucosal proctectomy with endorectal pull-through and an anorectal myotomy (stage 2) were performed, and two weeks later a coloanal anastomosis (stage 3) was created.