swensons pullthrough in older children and adults peculiar perioperative challenges of surgery introduction the definitive treatment of hirschsprungs disease is removal of the aganglionic bowel by a pullthrough surgery in most cases this surgery is performed in infancy or the neonatal period as presentation in older children and adulthood is rare nevertheless pullthrough in this age group may be necessary and present peculiar challengesmaterialsmethods a prospective study of patients above 5 years with hirschsprungs disease who presented at luth lagos between january 2007 and july 2010results there were fourteen patients 10 males and 4 females the median age was 9 years range 531 years all the patients presented with constipation and abdominal distension seven patients presented with intestinal obstruction necessitating colostomy thirteen patients had short segment hirschsprungs disease limited to the rectosigmoid the only exception had long segment disease with the transition zone located at the transverse colon ten patients 714 had colostomy before definitive pullthrough while four patients 286 had primary pullthrough procedure without a colostomy the definitive pullthrough procedure done in all the patients was swensons abdominoperineal pullthrough and all the patients had a 2layered coloanal anastomoses due to the rigid pelvis in these patients as well as possible scarring simple blunt dissection was difficult in these cases the median length of follow up was 11 months range 628 months there was one case 71 of mortalityconclusion older patients with hirschsprungs disease present with intestinal obstruction and poor nutritional status that may necessitate preoperative colostomy swensons pullthrough in them poses peculiar challenges of mobilization of bowel and achieving a reliable coloanal anastomosis however outcome is comparable with surgery in younger children if these challenges are overcome