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Pediatric Surgery International

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01-02-2019 | Original Article

Risk factors for the development of post-operative enterocolitis in short segment Hirschsprung’s disease

Authors: Patrick Ho Yu Chung, Michelle On Na Yu, Kenneth Kak Yuen Wong, Paul Kwong Hang Tam

Published in: Pediatric Surgery International | Issue 2/2019

Abstract

Aim of the study

The objective of this study is to identify risk factors associated with the development of post-operative enterocolitis (HAEC), in short segment Hirschsprung’s disease (HSCR-S).

Methods

A retrospective study was carried out for post-operative patients with HSCR-S from 1997 to 2017. HSCR-S was defined as the most proximal extension of aganglionosis limited to the sigmoid colon. An episode of HAEC was defined as the presence of (1) vomiting or explosive diarrhea; (2) abdominal distension; (3) fever and (4) leukocytosis. Risk factors for the development of HACE were determined using multivariate logistic regression.

Main results

The medical records of 96 patients were reviewed. The overall incidence of HAEC was 20.8% (n = 20) and 65.0% (n = 13) of HAEC occurred within the first year of operation. After a univariate logistic regression analysis, three risk factors for HAEC were identified: (1) presence of other major anomalies [OR: 1.43 (1.12–2.32), p = 0.041]; (2) creation of pre-operative defunctioning stoma [OR: 2.28 (1.47–3.23), p = 0.035]; (3) extension of aganglionosis to the sigmoid colon [OR: 1.89 (1.05–3.19), p = 0.049]. After multivariate logistic regression analysis, a significant association was demonstrated for creation of pre-operative defunctioning stoma [OR: 1.81 (1.08–3.22), p = 0.045] and extension of aganglionosis to the sigmoid colon [OR: 1.91 (1.37–2.98), p = 0.038].

Conclusions

The requirement of pre-operative defunctioning stoma and a more proximal extension of aganglionosis are risk factors for the development of post-operative HAEC in HSCR-S. Patients with these risk factors should be closely followed up especially during the first year after the operation.

Gosain A, Brinkman AS (2015) Hirschsprung’s associated enterocolitis. Curr Opin Pediatr 27(3):364–369CrossRefPubMedPubMedCentral

Demehri FR, Halaweish IF, Coran AG, Teitelbaum DH (2013) Hirschsprung-associated enterocolitis: pathogenesis, treatment and prevention. Pediatr Surg Int 29(9):873–881CrossRefPubMed

Gosain A, Frykman PK, Cowles RA, Horton J, Levitt M, Rothstein DH et al (2017) Guidelines for the diagnosis and management of Hirschsprung-associated enterocolitis. Pediatr Surg Int 33(5):517–521CrossRefPubMedPubMedCentral

Murphy F, Puri P (2005) New insights into the pathogenesis of Hirschsprung’s associated enterocolitis. Pediatr Surg Int 21(10):773–779CrossRefPubMed

Ruttenstock E, Puri P (2010) Systematic review and meta-analysis of enterocolitis after one-stage transanal pull-through procedure for Hirschsprung’s disease. Pediatr Surg Int 26(11):1101–1105CrossRefPubMed

Tam PKH, Chung PHY, St Peter SD, Gayer CP, Ford HR, Tam GCH et al (2017) Advances in paediatric gastroenterology. Lancet 390(10099):1072–1082CrossRefPubMed

Vieten D, Spicer R (2004) Enterocolitis complicating Hirschsprung’s disease. Semin Pediatr Surg 13(4):263–272CrossRefPubMed

Parahita IG, Makhmudi A, Gunadi (2018) Comparison of Hirschsprung-associated enterocolitis following Soave and Duhamel procedures. J Pediatr Surg 53(7):1351–1354CrossRefPubMed

Frykman PK, Short SS (2012) Hirschsprung-associated enterocolitis: prevention and therapy. Semin Pediatr Surg 21(4):328–335CrossRefPubMedPubMedCentral

10.

El-Sawaf M, Siddiqui S, Mahmoud M, Drongowski R, Teitelbaum DH (2013) Probiotic prophylaxis after pullthrough for Hirschsprung disease to reduce incidence of enterocolitis: a prospective, randomized, double-blind, placebo-controlled, multicenter trial. J Pediatr Surg 48(1):111–117CrossRefPubMed

11.

Chung PHY, Wong KKY, Tam PKH, Leung MWY, Chao NSY, Liu KKW et al (2018) Are all patients with short segment Hirschsprung’s disease equal? A retrospective multicenter study. Pediatr Surg Int 34(1):47–53CrossRefPubMed

12.

Beamish EL, Johnson J, Shaw EJ, Scott NA, Bhowmick A, Rigby RJ (2017) Loop ileostomy-mediated fecal stream diversion is associated with microbial dysbiosis. Gut Microbes 8(5):467–478CrossRefPubMedPubMedCentral

13.

Teitelbaum DH, Qualman SJ, Caniano DA (1988) Hirschsprung’s disease. Identification of risk factors for enterocolitis. Ann Surg 207(3):240–244CrossRefPubMedPubMedCentral

14.

Hackam DJ, Filler RM, Pearl RH (1998) Enterocolitis after the surgical treatment of Hirschsprung’s disease: risk factors and financial impact. J Pediatr Surg 33(6):830–833CrossRefPubMed

15.

Dong Q, Li G, Dong J. Identification of risk factors for postoperative recurrent Hirschsprung associated enterocolitis. J Pediatr Surg. 2018

16.

Wildhaber BE, Pakarinen M, Rintala RJ, Coran AG, Teitelbaum DH (2004) Posterior myotomy/myectomy for persistent stooling problems in Hirschsprung’s disease. J Pediatr Surg 39(6):920–926 (discussion—6)CrossRefPubMed

Title: Risk factors for the development of post-operative enterocolitis in short segment Hirschsprung’s disease
Authors: Patrick Ho Yu Chung
Michelle On Na Yu
Kenneth Kak Yuen Wong
Paul Kwong Hang Tam
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 2/2019
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-018-4393-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors for the development of post-operative enterocolitis in short segment Hirschsprung’s disease

Abstract

Aim of the study

Methods

Main results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Aim of the study

Methods

Main results

Conclusions

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