Approach to anal sphincter dysfunctions in a patient with endorectal pull-through procedure

The seven-year-old male patient was examined in the pediatric surgery outpatient unit with abdominal distension. He had been operated on for congenital megacolon in the newborn period in another center. After a period of follow-up, he had been re-operated because of a diagnosis of insufficient pull-through, and a second pull-through had been performed. Following this procedure, myectomy and temporary colostomy procedures were reported in a different hospital. After all these treatments, he still had a distension episode, even associated with enterocolitis. In our clinic, we medically treated enterocolitis four times in 5 months. According to the council decision in our department, we decided to use a medically used botulin toxin (Botox) to evaluate a possible internal anal sphincter achalasia (IASA) and injected the Botox into the internal sphincter under anesthesia. Following the procedure, the patient was brought to our attention only once in 4 months with a mild distension. This data encouraged us to perform partial sphincteromy and internal sphincter myectomy. Nine months after the myectomy, the patient was not hospitalized and had a mild distension once. There is a significant improvement in his life quality; as a clear result, we observed and experienced that sphincter-related problems must be taken into account in incurable postoperative obstructive situations related to Hirschsprung's disease.