NORCET-7 Mains-2024: Swenson and Duhamel procedure used to correction of?

NORCET-7 Mains-2024

Child Health Nursing (Pediatrics)

Easy

Appeared in: NORCET-7 Mains-2024

Explanation

Hirschsprung's disease is a congenital condition characterized by the absence of ganglion nerve cells in a segment of the colon, leading to a functional obstruction.
The Swenson and Duhamel procedures are definitive surgical treatments for this condition.
Both are 'pull-through' techniques that involve removing the defective (aganglionic) bowel and connecting the healthy (ganglionated) bowel to the anus to restore normal function.
The Swenson procedure involves a direct end-to-end anastomosis, while the Duhamel procedure creates a side-to-side anastomosis behind the rectum.

Option A: Diverticulitis is an acquired inflammatory condition, not a congenital defect of nerve cells. Its surgical management involves resecting the inflamed colon segment, often with a temporary or permanent colostomy (Hartmann's procedure), which is fundamentally different from a pull-through procedure.
Option B: Intussusception is a telescoping of the bowel. The primary treatment is non-surgical reduction using a therapeutic enema. Surgery is only indicated if this fails or if there is bowel perforation or necrosis.
Option D: Volvulus is the twisting of the bowel. It is a surgical emergency requiring immediate detorsion (untwisting). If caused by malrotation, a Ladd procedure is performed to prevent recurrence. This is different from the resection and pull-through technique of the Swenson/Duhamel procedures.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Surgical management of congenital gastrointestinal disorders as background academic context rather than a clinical decision trigger.
Nurses play a critical role in the pre- and post-operative care of infants with Hirschsprung's disease. Pre-operatively, this includes managing constipation with saline enemas (never tap water, to avoid water intoxication) and monitoring for signs of enterocolitis.
Post-operatively, care focuses on monitoring for complications like anastomotic leak or stricture, managing pain, providing meticulous perineal care to prevent skin breakdown, and educating parents on long-term bowel management and signs of complications.
What if? If a newborn fails to pass meconium within the first 24-48 hours and develops abdominal distention and bilious vomiting, the nurse should have a high index of suspicion for Hirschsprung's disease and escalate to the physician for further evaluation, such as a contrast enema or rectal biopsy.

How to Approach the Question

First, identify the keywords in the question stem: 'Swenson' and 'Duhamel procedure'. Recognize these as specific, named surgical techniques.
This is a factual recall question. The task is to match the named procedures to the correct medical condition.
Evaluate the options. All are gastrointestinal disorders.
Recall or deduce that Swenson and Duhamel are classic 'pull-through' procedures developed for a congenital defect of the colon.
Match this knowledge to the options. Hirschsprung's disease is the congenital aganglionic megacolon, which fits the description of the pathology corrected by these surgeries.
Eliminate the other options by recalling their standard treatments: Diverticulitis (medical/resection), Intussusception (enema reduction), and Volvulus (detorsion).

Concept Tested & Keywords

QIamDNbOqvxrAlFssfLnFL

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 64-66, 65-67

E6 Medicine Harrison 22e Part 2 p. 486-488