Table 1. Differential diagnosis of obstructive and soiling symptoms after pull-through for HD (adapted from Langer et al., 2017 and Saadai et al., 2019).
| Symptom | Diagnoses |
|---|---|
| Soiling symptoms | |
| Pseudo-incontinence | Overflow incontinence |
| Hypermotility | |
| Abnormal sensation | Damage to the dentate line |
| Neo-rectum insensitivity | |
| Damaged sphincter | Over-stretch during pull-through |
| Prior sphincterotomy or myectomy | |
| Obstructive symptoms | |
| Mechanical obstruction | Anastomotic stricture |
| Twisted pull-through | |
| Obstructing muscular cuff | |
| Obstructing Duhamel pouch | |
| Postoperative adhesions | |
| Pathologic obstruction | Aganglionic pull-through |
| Transition zone pull-through | |
| Internal anal sphincter achalasia | – |
| Hypomotility | Focal hypomotility |
| Diffuse hypomotility | |
| Functional megacolon | Stool holding behavior |
HD, Hirschsprung disease.