Penile agenesis (aphallia) is an exceptionally rare congenital anomaly with an estimated incidence of one in 10 to 30 million live births. We report a full-term male neonate with complete penile agenesis, a normally developed scrotum with bilaterally palpable testes, and passage of urine through the anus. Investigations revealed a rectovesical fistula, horseshoe kidneys with mild pelvicalyceal dilatation, and aganglionic megacolon, a previously unreported triple association. Suprapubic cystostomy was performed at day seven. Male sex assignment was chosen based on 46,XY karyotype and Islamic ethical guidance, with staged phalloplasty planned.

Ulcerative colitis-associated colonic dilatation is clinically important because it may progress to perforation or toxic megacolon. However, surgical decision-making is difficult when systemic toxicity is absent. An 83-year-old woman with long-standing pancolitis-type ulcerative colitis was admitted with worsening bloody diarrhea and abdominal pain. Despite high-dose corticosteroids and infliximab, computed tomography revealed marked colonic dilatation predominantly involving the transverse colon. Although she had anemia, she did not meet the Jalan criteria for toxic megacolon because she lacked high fever, marked tachycardia, leukocytosis, and additional signs of systemic deterioration. Serial abdominal radiographs showed progressive dilatation from approximately 70 mm to 95 mm despite intensive medical therapy. Surgery was selected after multidisciplinary reassessment. Histopathological examination revealed deep ulceration with erosion, broad disruption of the muscularis propria, and scar replacement in the dilated segment, indicating severe structural bowel-wall injury. No major postoperative complications occurred, although rehabilitation transfer was required because of decreased activities of daily living. This case suggests that persistent or progressive colonic dilatation in ulcerative colitis, even without systemic toxicity, may reflect advanced mural injury and should prompt repeated surgical assessment based on serial radiological findings.

Hirschsprung's disease is a common congenital gastrointestinal malformation in children, for which radical surgery remains the primary treatment modality. Postoperatively, patients are prone to complications such as Hirschsprung-associated enterocolitis, defecation dysfunction, anal stenosis, and psychological or behavioral abnormalities, all of which significantly impair growth, development, and quality of life. As a critical bridge linking inpatient treatment with home-based rehabilitation, continuous nursing care has demonstrated efficacy in enhancing post-discharge outcomes, reducing complication risks, and improving long-term prognosis. This review systematically synthesizes the extant literature concerning continuity of care following radical surgery for pediatric Hirschsprung disease, both domestically and internationally. It delineates the core constructs, clinical significance, prevailing care models, key intervention strategies, and outcome evaluation frameworks within this domain, while concurrently summarizing current research deficiencies and projecting future developmental trajectories. The paper critically appraises recent advances in novel modalities-specifically informatized smart nursing, individualized precision care, and multidisciplinary collaborative care-and consolidates optimization outcomes related to core interventions, including bowel rehabilitation, complication surveillance, empowerment of family caregivers, and psychosocial support. Addressing identified gaps, this review proposes strategic directions encompassing the establishment of standardized nursing protocols, deeper integration of intelligent technologies, implementation of long-term prognostic surveillance, and deployment of precision interventions for high-risk pediatric subgroups. Notably, parental educational level is identified as a critical confounding variable exerting significant influence on home-care quality and rehabilitation efficacy; consequently, subsequent investigations should incorporate this metric into stratified analyses and nursing quality control systems. This synthesis aims to provide an evidence-based foundation for the standardized implementation of postoperative continuity of care and the optimization of rehabilitation management pathways, thereby propelling the evolution of pediatric surgical nursing toward enhanced standardization, precision, and intelligence.

Hirschsprung disease (HSCR) results from incomplete distal bowel colonization by enteric neural crest-derived cells. Macrophage-enteric nervous system (ENS) interactions may influence postnatal neuromuscular function and Hirschsprung-associated enterocolitis (HAEC), but direct evidence that macrophages initiate embryonic aganglionosis is limited. This focused narrative review therefore treats postnatal dysmotility and HAEC as its primary focus and examines prenatal development chiefly to define the boundary of causal claims. In the normal muscularis, macrophage-neuron interactions contribute to ENS refinement and maintenance. A proposed bone morphogenetic protein 2 and colony-stimulating factor 1 circuit has influenced the field, although recent deletion studies question whether macrophage-derived bone morphogenetic protein 2 controls motility. In HSCR, the strongest disease-specific evidence concerns secondary neuromuscular dysfunction and HAEC. Pro-inflammatory macrophages can induce an interstitial cell of Cajal C-KIT phenotypic switch through a TNF-α, NF-κB and miR-221 pathway, while microbial, stromal and epithelial signals can further modify macrophage function. These mechanisms may help explain persistent dysmotility and enterocolitis susceptibility, but no macrophage biomarker or macrophage-directed treatment has established clinical utility. Current care remains based on prompt recognition, bowel decompression, antibiotics and correction of obstructive causes. Available evidence supports macrophages as modifiers of postnatal dysfunction, not as a proven primary cause of aganglionosis.

Hirschsprung's disease (HD) is characterised by absence of ganglion cells in the distal large intestine, requiring accurate histopathological diagnosis. Conventional diagnostic methods are time-consuming, subjective, and demand specialised expertise. While artificial intelligence (AI) shows promise for improving diagnostic capacity, its clinical utility requires rigorous evaluation. Following PRISMA 2020 guidelines, this systematic review evaluated machine and deep learning techniques for HD diagnosis from histopathological images. A search of seven databases identified thirteen eligible studies (2016-2025). Studies were analysed for model architecture, computational workflows and diagnostic performances. Methodological quality and risk of bias were assessed using QUADAS-AI and PROBAST frameworks. HD image analysis has progressed from traditional processing to convolutional neural networks and transformer models. Deep learning outperformed conventional approaches with > 90% in ganglion cell detection and reducing diagnostic time by 50-95%. However, nine studies (69%) exhibited a high risk of bias due to small sample sizes, patch-level data partitioning, and lacking external test sets, raising concerns regarding overfitting and data leakage. AI methods demonstrated strong potential to support HD diagnosis by increasing accuracy, reducing variability and accelerating clinical decision-making. Future research should prioritise large multi-centre datasets, diverse staining techniques, external validation, and transparent reporting to facilitate reliable clinical integration.