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Congenital — usually diagnosed in infancy

Hirschsprung Disease

Specialized surgical care for Hirschsprung disease at the Colorectal Center at Nicklaus Children's Hospital — from the newborn diagnosis to reoperative reconstruction for children who haven't done well elsewhere.

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What is Hirschsprung disease?

In Hirschsprung disease, the nerve cells that tell the bowel to relax and move stool are absent from the end of the intestine. That segment stays tightly closed, and stool backs up behind it. Most children are diagnosed as newborns — they don't pass their first stool, or the belly becomes swollen — though milder cases can surface later in childhood.

The definitive treatment is a pull-through operation: the affected segment is removed and the healthy, nerve-containing bowel is connected down to the anus, preserving the anal canal. Done well, most children go on to thrive. The harder questions come afterward — soiling, recurrent obstruction, or enterocolitis — and that is where precise evaluation matters most.

How Dr. Calisto approaches it

  • Primary transanal and minimally invasive pull-through, tailored to the length of affected bowel
  • Structured re-evaluation of children who continue to struggle after a prior pull-through
  • Published work on the anal canal as the dividing line between continence and colitis after pull-through
  • Ongoing bowel-management partnership so families aren't left to manage symptoms alone

Why families come to Dr. Calisto

Dr. Calisto is a triple board-certified pediatric surgeon and Director of the Colorectal Center at Nicklaus Children's Hospital — Florida's first comprehensive pediatric colorectal program. Many families arrive for a second opinion, and that is exactly the right time to ask.

  • Triple board-certified pediatric surgeon
  • Director of Florida's first comprehensive pediatric colorectal center
  • Reoperative (redo) pull-through expertise for children doing poorly after earlier surgery
  • Dedicated, long-term bowel management program

Frequently asked questions

What causes Hirschsprung disease?
During pregnancy, nerve cells normally grow along the entire bowel. In Hirschsprung disease that growth stops early, leaving the last part of the bowel without nerves. Nothing a parent did or didn't do causes it. It is present from birth and is sometimes linked to other genetic conditions, which is why a full evaluation matters.
How is it diagnosed?
It's often suspected in newborns who don't pass their first stool within a day or two, or who have a swollen belly and trouble feeding. Older children may have severe, lifelong constipation. The diagnosis is confirmed with a rectal biopsy — a small tissue sample checked for nerve cells — sometimes alongside a contrast enema X-ray.
What does the surgery involve?
The operation is called a pull-through. The surgeon removes the segment of bowel without nerves and connects the healthy bowel above it to the anus, preserving the anal canal so the child can control bowel movements. Many pull-throughs are done in a single, minimally invasive operation.
My child had a pull-through elsewhere and isn't doing well — can that be helped?
Yes. Caring for children who continue to have soiling, obstruction or enterocolitis after an earlier pull-through is a core part of specialized colorectal practice. A careful re-evaluation can identify what's happening and whether reoperative surgery or a tailored management plan would help.

Talk with Dr. Calisto

Whether this is a new diagnosis or a second opinion after care elsewhere, an early conversation often changes the plan for the better. Pediatricians and families are welcome to reach out directly.

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