Sir,
Modified Duhamel's operation is a common procedure for treating Hirschsprung's disease.[1]
The original Duhamel's operation was modified to crush the spur (common wall) between aganglionic rectal stump, and pulled through ganglionic bowel. Kocher's clamps, Irani's clamp and linear G.I.A. stapler[2] have been used to eliminate the spur (common wall).
We present a 1-year-old child, diagnosed with Hirschsprung's disease on rectal biopsy. He had undergone a prior colostomy with multiple sero-muscular biopsies at 2 months of age, followed by a modified Duhamel's operation with stapler at 10 months of age. Two rounds of linear stapler were fired to tackle the spur. He was doing fine after definitive surgery and came for stoma closure.
A distal cologram performed [Figure 1] showed a residual spur. This was confirmed on rectal examination and sigmoidoscopy. The spur measured about 12 cm in length, with a narrow posterior rectal compartment and a roomy anterior compartment.
Figure 1.
Distal cologram with Gastrografin after modified Duhamel's surgery shows a residual rectal spur
This spur was successfully divided using a Harmonic scalpel. The procedure was quick and bloodless.
This case is presented to describe a novel method of managing a residual rectal spur, post modified Duhamel's operation.
The method is quick and bloodless and a useful alternative to painful spur crushing clamps or a linear stapler.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
We are sincerely thankful to Department of Paediatric Surgery, Dr. D.Y. Patil Medical College Hospital and Research Centre, PCMC Pune 411018 for helping in our endeavor.
REFERENCES
- 1.Bradnock TJ, Walker GM. E37 open Duhamel pull-through. In: Carachi R, Agarwala S, Bradnock TJ, Lim Tan H, Cascio S, editors. Basic Techniques in Pediatric Surgery. Berlin, Heidelberg: Springer; 2013. [Google Scholar]
- 2.Elsherbeny M, Abdelhay S. Obstructive complications after pull-through for Hirschsprung's disease: different causes and tailored management. Ann Pediatr Surg. 2019;15(2):3. [Google Scholar]