A staged laparoscopic endorectal pull-through for adult Hirschsprung disease: a case report
Lory Hage, Rodrigue Chemaly, Jana Moukahal, Roy Ibrahim, Rajaa Chatila, Georges Al HajjIntroduction:
Adult Hirschsprung disease (HD) is a rare congenital disorder frequently misdiagnosed as chronic refractory constipation, leading to diagnostic delays and prolonged morbidity. This case is unique in describing a staged laparoscopic endorectal pull-through (LERPT) without a diverting stoma and in adapting a well-established pediatric technique to the anatomical and physiological challenges of the adult rectum.
Case presentation:
A 38-year-old male with a history suggestive of neonatal bowel dysfunction presented with recurrent severe constipation, abdominal distension, and pain. Systematic full-thickness rectal and colonic biopsies confirmed rectosigmoid HD (absent ganglion cells, negative calretinin staining). A modified two-stage Soave LERPT was performed: transanal mucosectomy was initiated 2 cm above the dentate line, followed by laparoscopic resection of the aganglionic segment, transanal exteriorization of the healthy colon, and delayed coloanal anastomosis without a diverting stoma. Postoperative recovery was uncomplicated.
Conclusion:
A staged laparoscopic Soave pull-through without a diverting stoma is feasible and effective in selected adults with HD. Adult HD must be actively considered in patients with lifelong refractory constipation. Multidisciplinary planning and individualized technique selection are essential to optimize functional outcomes.