Enterocolitis following endorectal pull-through procedure in children with Hirschsprung's disease

Abstract

The enterocolitis following a pull-through in Hirschsprung's disease can be life-threatening and difficult to distinguish clinically from gastroenteritis and post-operative complications. We reviewed retrospectively the abdominal radiographs in our series to identify specific radiographic characteristics of this syndrome in this population. A total of 55 episodes of enterocolitis with an abdominal series at presentation were located in the files of 43 patients following pull-through surgery for Hirschsprung's disease. There were 15 abdominal series with other complications of Hirschsprung's disease and surgery (seven cases of small bowel obstruction, one of fistula, one of abscess, six of severe constipation) and 71 surveillance follow-up studies. Radiographs were evaluated for bowel dilatation, air-fluid levels, intestinal cut-off sign, speculation, and pneumatosis. The intestinal cut-off sign with two or more air-fluid levels had sensitivity of 68% and specificity of 83%, with a positive predictive value of 0.71 and overall accuracy of 77%. Our review of enterocolitis following pull-through in children with Hirschsprung's disease concludes that the constellation of an intestinal cut-off sign and at least two air-fluid levels on the abdominal series strongly suggests the diagnosis.

Response to Orvar Swenson’s Hirschsprung’s disease—A complicated therapeutic problem: Some thoughts and solutions based on data and personal experience over 56 years

“…Our own experience with HAEC confirms the above findings. [1][2][3][4] Recent data from our institution have suggested that MUC-2, the predominant mucin gene, is markedly reduced in patients with Hirschsprung's disease and is absent in patients with HAEC. MUC-2 has been shown to be important in preventing bacterial translocation.…”

Essential Diagnosis of Abdominal Emergencies in the First Year of Life

“…Radiographs typically will show air fluid levels and the absence of air in the distal rectosigmoid colon [68]. Pneumatosis intestinalis also may be seen on radiograph [64,68]. Spontaneous perforation is estimated to occur in about 3% of patients [66].…”

“…It is associated with fever, abdominal distention, bilious vomiting, explosive diarrhea, volume depletion, and shock [63,64]. Radiographs typically will show air fluid levels and the absence of air in the distal rectosigmoid colon [68]. Pneumatosis intestinalis also may be seen on radiograph [64,68].…”

Relationships between Myers-Briggs Type Indicator (MBTI) Psychological Type and Marital Satisfaction, Divorce Proneness, Positive Affect, and Conflict Regulation in Clinic Couples

“…[175][176][177][178] Most surgeons with substantial experience in the treatment of Hirschsprung's disease have been through the frustrating experience of some patients experienc-ing enterocolitis, whereas other patients who undergo the operation with the same technique behave like normal children. Postoperative Enterocolitis.-Even with a technically correct operation, enterocolitis may occur after the operation.…”