Management of Hirschsprung's Associated Enterocolitis as a Post-Operative Complication: Single-Center Experience Management of Hirschsprung's Associated Enterocolitis as a Post-Operative Complication: Single-Center Experience
Iranian Journal of Pediatric Surgery,
Vol. 10 No. 2 (2024),
30 October 2024
,
Page 179-192
https://doi.org/10.22037/irjps.v10i2.45743
Abstract
Introduction: Enterocolitis is a potentially fatal consequence of Hirschsprung’s disease, it is characterized by fever, abdominal pain, foul-smelling diarrhea, and sepsis. Most neonatal morbidity and mortality are caused by Hirschsprung-associated enterocolitis (HAEC). Harald Hirschsprung initially discovered Hirschsprung's related enterocolitis in the 19th century and included it in his iconic description of megacolon. Trisomy 21, illness, familial history, and prior bouts of HAEC are risk factors for the condition. (3,4) According to Engun et al. patients who presented with a history of Hirschsprung's disease had a 35% incidence of HAEC, but those without such a history only had a 16% incidence. Similarly, HSD and trisomy 21 have a known association with 2.9 - 8.2% of HSD patients also having trisomy 21. This study aimed to evaluate HAEC as a postoperative complication in children who were admitted after pull-through surgery as regards the type of surgery, incidence, clinical presentation, sepsis workup, and management in Alexandria University Children’s Hospital.
Materials and Methods: This retrospective study included 30 patients with Hirschsprung disease who developed post-operative Hirschsprung-associated enterocolitis and were scheduled for surgical intervention from January 2021 to 2022.
Results: In the studied group, the most commonly used pull-through procedure was the Soave (53.33%), followed by the Duhamel procedure (20%). Fewer subjects were operated using the Swenson and Rehbein methods, at 16.67% and 10% respectively. Most of our studied patients (26 patients) presented with signs and symptoms of Grade I HAEC, while 3 patients with Grade II and 1 patient with Grade III.
Conclusion: Post-operative HAEC is a serious complication and needs to proper management to save the child either conservative treatment, repeated anal dilatation or surgical intervention in severe cases.
- Hirschsprung-Associated Enterocolitis
- Contrast Enema
- Pull-Through
- Megacolon
How to Cite
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