Hirschsprung's disease most commonly affects which segment of the colon, and what is the surgical principle of the Swenson pull-through procedure?

• A Sigmoid colon; resection with colostomy and delayed anastomosis
• B Transverse colon; side-to-side anastomosis bypassing the aganglionic segment
• C Rectosigmoid; pull-through of ganglionated bowel to the anus with resection of the aganglionic segment ✓
• D Total colon; ileostomy with no primary anastomosis

Explanation

Hirschsprung's disease most commonly affects the rectosigmoid region (~75%). The Swenson procedure (original definitive repair) involves resecting the aganglionic segment and performing a pull-through of normoganglionic bowel to just above the internal sphincter with a coloanal anastomosis. Duhamel (retrorectal pull-through with side-to-side anastomosis) and Soave (endorectal pull-through) are alternatives. All aim to bring ganglionated bowel to the anal canal.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.