Year 2019 Vol. 27 No 4




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 patients 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.

Keywords: Hirschsprung disease, agangliosis, colon, enterocolitis, transanal endorectal pull-through, postoperative complications
p. 421-427 of the original issue
  1. Swenson O. Hirschsprungs disease: a review. Pediatrics. 2002 May;109(5):914-18.
  2. Holschneider AM, Puri P, eds. Hirschsprungs disease and allied disorders. 3rd ed. New York, NY: Springer; 2008. 414 p.
  3. Dasgupta R, Langer JC. Hirschsprung disease. Curr Probl Surg. 2004 Dec;41(12):942-88. doi: 10.1067/j.cpsurg.2004.09.004
  4. Langer JC, Rollins MD, Levitt M, Gosain A, Torre L, Kapur RP, Cowles RA, Horton J, Rothstein DH, Goldstein AM. Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease. Pediatr Surg Int. 2017 May;33(5):523-26. doi: 10.1007/s00383-017-4066-7
  5. Thakkar HS, Bassett C, Hsu A, Manuele R, Kufeji D, Richards CA, Agrawal M, Keshtgar AS. Functional outcomes in Hirschsprung disease: A single institutions 12-year experience. J Pediatr Surg. 2017 Feb;52(2):277-80. doi: 10.1016/j.jpedsurg.2016.11.023
  6. Adıgüzel Ü, Ağengin K, Kırıtıoğlu I, Doğruyol H. Transanal endorectal pull-through for Hirschsprungs disease: experience with 50 patients. Ir J Med Sci. 2017 May;186(2):433-37. doi: 10.1007/s11845-016-1446-2
  7. Khazdouz M, Sezavar M, Imani B, Akhavan H, Babapour A, Khademi G. Clinical outcome and bowel function after surgical treatment in Hirschsprungs disease. Afr J Paediatr Surg. 2015 Apr-Jun;12(2):143-47. doi: 10.4103/0189-6725.160403
  8. Yan Z, Poroyko V, Gu S, Zhang Z, Pan L, Wang J, Bao N, Hong L. Characterization of the intestinal microbiome of Hirschsprungs disease with and without enterocolitis. Biochem Biophys Res Commun. 2014 Mar 7;445(2):269-74. doi: 10.1016/j.bbrc.2014.01.104
  9. Gosain A, Brinkman AS. Hirschsprungs associated enterocolitis. Curr Opin Pediatr. 2015 Jun;27(3):364-69. doi: 10.1097/MOP.0000000000000210
  10. Kwendakwema N, Al-Dulaimi R, Presson AP, Zobell S, Stevens AM, Bucher BT, Barnhart DC, Rollins MD. Enterocolitis and bowel function in children with Hirschsprung disease and trisomy 21. J Pediatr Surg. 2016 Dec;51(12):2001-2004. doi: 10.1016/j.jpedsurg.2016.09.026
  11. Lu C, Hou G, Liu C, Geng Q, Xu X, Zhang J, Chen H, Tang W. Single-stage transanal endorectal pull-through procedure for correction of Hirschsprung disease in neonates and nonneonates: A multicenter study. J Pediatr Surg. 2017 Jul;52(7):1102-1107. doi: 10.1016/j.jpedsurg.2017.01.061
  12. Wang X, Li Z, Xu Z, Wang Z, Feng J. Probiotics prevent Hirschsprungs disease-associated enterocolitis: a prospective multicenter randomized controlled trial. Int J Colorectal Dis. 2015 Jan;30(1):105-10. doi: 10.1007/s00384-014-2054-0
  13. Bogolepov NN. Metody elektronno-mikroskopicheskogo issledovaniia mozga [Elektronnyi resurs]. Moscow: Izd in-ta mozga AMN SSSR; 1976. 72 p. (In Russ.)
Address for correspondence:
220013, The Republic of Belarus,
Minsk, Nezavisimosti Ave., 64,
Republican Research and Practical Center for Pediatric Surgery,
Purulent Unit 2 (Surgical),
Tel. +375 29 772-31-34,
Olga A. Govorukhina
Information about the authors:
Govorukhina Olga A., PhD, Associate Professor, Head of the Purulent Unit 2 (Surgical), Republican Research and Practical Center for Pediatric Surgery, Minsk, Republic of Belarus.
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