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Year 2019 Vol. 27 No 4
CAUSES OF POSTOPERATIVE ENTEROCOLITIS IN HIRSCHSPRUNG DISEASE IN CHILDREN
Republican Research and Practical Center for Pediatric Surgery, Minsk,
The Republic of Belarus
Objective. To analyze the causes for the development of enterocolitis in the group of patients with Hirschsprung disease after radical surgical treatment in order to prevent its occurrence and improve treatment outcomes.
Methods. During the period for 2010-2018, 92 patients with Hirschsprung disease at the age of 1 month up to 16 years were operated at the Center for Pediatric Surgery by the transanal endorectal pull-through (TEPT) method (in various versions). All patients with the signs of postoperative enterocolitis were included in this study. The clinical manifestations of the disease, age of patients at the time of radical surgical treatment, the form of Hirschsprung disease, changes in the morphological picture of bowel biopsy material were assessed.
Results. During the period of 2010-2018, cases of enterocolitis of mild and moderate severity prevailed in the study group (19 patients with postoperative enterocolitis – 27.2% of the total number of patients). Surgery was required in 8 cases of severe postoperative enterocolitis. The occurrence of postoperative enterocolitis was established to not depend on the patient’s age at the time of the radical operation (p>0.05). The main causes for the occurrence of postoperative enterocolitis were the following: a long zone of bowel resection in the extended agangliosis and the presence of previous enterocolitis in the history prior to radical surgery. Also, during the morphological study of the operative material with electron microscopic examination, it was revealed that immune cells (eosinophils, mast cells) and endocrinocytes were subjected to destructive processes during enterocolitis in Hirschsprung disease, which contributed to the occurrence of recurrent enterocolitis after radical surgery.
Conclusions. The identification of the main causes of postoperative enterocolitis permitted to identify the group of patients who are likely to develop this serious complication of Hirschsprung disease. Timely and adequate prevention and treatment of postoperative enterocolitis improved patients’ treatment outcomes.
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220013, The Republic of Belarus,
Minsk, Nezavisimosti Ave., 64,
Republican Research and Practical Center for Pediatric Surgery,
Purulent Unit ¹2 (Surgical),
Tel. +375 29 772-31-34,
Olga A. Govorukhina
Govorukhina Olga A., PhD, Associate Professor, Head of the Purulent Unit ¹2 (Surgical), Republican Research and Practical Center for Pediatric Surgery, Minsk, Republic of Belarus.