Inpatient management of Hirschsprung’s associated enterocolitis treatment: the benefits of standardized care

Svetanoff, Wendy Jo; Dekonenko, Charlene; Osuchukwu, Obiyo; Oyetunji, Tolulope A.; Aguayo, Pablo; Fraser, Jason D.; Juang, David; Snyder, Charles L.; Hendrickson, Richard J.; Peter, Shawn St.; Rentea, Rebecca M.

doi:10.1007/s00383-020-04747-4

Cited by 10 publications

(6 citation statements)

References 21 publications

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“…Most of them would not be transferred to our center for radical surgery until presenting more severe symptoms [11] . This may also explain why the incidence of preoperative enterocolitis was relatively lower in our study than in most previous literature [12,13] . Secondly, the delayed referral of HD patients from primary or secondary healthcare facilities to tertiary health facility is responsible for the later age at radical surgery.…”

Section: Discussioncontrasting

confidence: 45%

Surgical outcomes for patients with rectosigmoid Hirschsprung disease after 1 year of age following transanal endorectal pull-through

xie,

Yan,

Wang

et al. 2023

Preprint

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Purpose: This study aimed to compare the differences in postoperative complications and long-term bowel function outcomes between patients with rectosigmoid Hirschsprung disease (HD) who underwent transanal endorectal pull-through (TEPT) beyond infancy (age＞ 1 year of age) and those during infancy (≤ 1 year of age). Methods: All patients with rectosigmoid HD at Beijing Children’s Hospital between January 2011 and December 2020 were eligible. They were divided into two groups based on age at TEPT: group A was defined as patients who performed TEPT beyond infancy (age＞1 year of age), and group B as patients who performed TEPT during infancy (age≤ 1 year of age). Clinical details were collected from medical records. Bowel function outcomes were assessed by the Rintala questionnaire (age≥4 years). Results: A total of 339 patients were included: 216 (63.7%) who operated with TEPT beyond infancy and 123 (36.3%) during infancy (group B). Regarding postoperative complications, all patients sufferinga anastomosis leakage following TEPT (7/216, 3.2%) occurred in group A and the rate of anastomosis leakage in group A was significantly higher than in group B (3.2% vs 0.0%, p=0.044). 228 patients (228/327, 69.7%) completed the Rintala questionnaire. There was no significant difference in long-term bowel function outcomes between the two groups. Conclusion: Compared with patients who performed TEPT during infancy, those beyond infancy are more likely to suffer anastomosis leakage, but long-term bowel function outcomes are comparable. TEPT should be performed during infancy for HD patients. Type of Study: A retrospective single-center study Level of evidence: Ⅲ

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Section: Discussioncontrasting

confidence: 45%

Surgical outcomes for patients with rectosigmoid Hirschsprung disease after 1 year of age following transanal endorectal pull-through

xie,

Yan,

Wang

et al. 2023

Preprint

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“…However, these patients are quite ill, often requiring intensive care unit level care, nasogastric decompression, and may need surgical management such as proximal bowel diversion. Several studies have shown that use of this standardized algorithm or other similar tools to guide management decreases length of stay, use of IV antibiotics, and readmission[ 48 , 49 ].…”

Section: Hirschsprung’s Disease Associated Enterocolitismentioning

confidence: 99%

Hirschsprung's disease associated enterocolitis: A comprehensive review

Es¹,

Rodriguez²,

Arbizu³

2023

World J Clin Pediatr

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Hirschsprung’s disease (HSCR) is a congenital disorder characterized by failure of the neural crest cells to migrate and populate the distal bowel during gestation affecting different lengths of intestine leading to a distal functional obstruction. Surgical treatment is needed to correct HSCR once the diagnosis is confirmed by demonstrating the absence of ganglion cells or aganglionosis of the affected bowel segment. Hirschsprung’s disease associated enterocolitis (HAEC) is an inflammatory complication associated with HSCR that can present either in the pre- or postoperative period and associated with increased morbidity and mortality. The pathogenesis of HAEC remains poorly understood, but intestinal dysmotility, dysbiosis and impaired mucosal defense and intestinal barrier function appear to play a significant role. There is no clear definition for HAEC, but the diagnosis is primarily clinical, and treatment is guided based on severity. Here, we aim to provide a comprehensive review of the clinical presentation, etiology, pathophysiology, and current therapeutic options for HAEC.

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“…The protocols for HAEC management vary by institution [ 92 ]. A sample algorithm for the diagnosis and treatment of enterocolitis is depicted in Figure 6 with family education being a critical component for detecting early symptoms of HAEC and its prevention by performing early irrigations at home [ 12 , 93 ].…”

Section: Hirschsprung-associated Enterocolitismentioning

confidence: 99%

State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease

Bokova,

Prasade,

Janumpally

et al. 2023

Children

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After an initial pull-though, patients with Hirschsprung disease (HD) can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or fecal soiling. This current review focuses on algorithms for evaluation and treatment in children with HD as a part of a manuscript series on updates in bowel management. In constipated patients, anatomic causes of obstruction should be excluded. Once anatomy is confirmed to be normal, laxatives, fiber, osmotic laxatives, or mechanical management can be utilized. Botulinum toxin injections are performed in all patients with HD before age five because of the nonrelaxing sphincters that they learn to overcome with increased age. Children with a patulous anus due to iatrogenic damage of the anal sphincters are offered sphincter reconstruction. Hypermotility is managed with antidiarrheals and small-volume enemas. Family education is crucial for the early detection of HAEC and for performing at-home rectal irrigations.

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Inpatient management of Hirschsprung’s associated enterocolitis treatment: the benefits of standardized care

Cited by 10 publications

References 21 publications

Surgical outcomes for patients with rectosigmoid Hirschsprung disease after 1 year of age following transanal endorectal pull-through

Surgical outcomes for patients with rectosigmoid Hirschsprung disease after 1 year of age following transanal endorectal pull-through

Hirschsprung's disease associated enterocolitis: A comprehensive review

State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease

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