Which factor most strongly predicts recurrent Hirschsprung-associated enterocolitis (HAEC) after pull-through surgery?
Answer: C
Explanation: The transitional zone contains hypoganglionic, poorly coordinated bowel. Leaving part of this zone behind after pull-through ? highest risk of recurrent HAEC, persistent constipation, obstruction.
Teaching Points: Teaching Point:
Incorrect level of pull-through (residual transition zone) is the #1 surgically correctable cause of postoperative HAEC.
A newborn has excessive salivation, choking during feeds, and inability to pass a nasogastric tube beyond 10 cm. Gas is absent in the abdomen. The most likely TEF variant is:
Answer: B
Explanation: Absence of intra-abdominal gas indicates no distal fistula, so the only possibilities are:
• Pure EA (Type A) – no gas in abdomen
• Very rare Type B – proximal fistula only
Since Type A is far more common than Type B ? it is the most likely.
Teaching Points: Abdominal gas = distal fistula.
No abdominal gas = pure esophageal atresia.