Skip to main content

Advertisement

SpringerLink
Log in

Predictive factors for the development of postoperative Hirschsprung-associated enterocolitis in children operated during infancy

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

The risk factors for postoperative Hirschsprung-associated enterocolitis (HAEC) are still incompletely understood, especially age at which surgery is performed. Therefore, the aim of this study was to identify the risk factors for the development of postoperative HAEC in children operated during infancy.

Methods

Thirty-five children who had undergone radical surgery for Hirschsprung disease (HD) during infancy were included in the study. They were divided into two groups; those who developed postoperative HAEC (HAEC, 14 patients) and those who did not (no HAEC, 21 patients). Their medical records were retrospectively reviewed for clinical details.

Results

Developing postoperative HAEC was significantly associated with long-segment HD (p = 0.020) and the age at radical surgery (p = 0.0241). No other factors had a significant association with postoperative HAEC. In the patients who developed postoperative HAEC (n = 14), those with Trisomy 21 had significantly longer hospitalizations than those without. Patients with long-segment HD had a higher hospitalization rate than those with short-segment HD.

Conclusion

This study clearly showed that long-segment HD and older age at radical surgery are risk factors for developing postoperative HAEC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Prato AP, Rossi V, Avanzini S et al (2011) Hirschsprung’s disease: what about mortality? Pediatr Surg Int 27:473–478. https://doi.org/10.1007/s00383-010-2848-2

    Article  Google Scholar 

  2. Langer JC, Rollins MD, Levitt M et al (2017) Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease. Pediatr Surg Int 33:523–526. https://doi.org/10.1007/s00383-017-4066-7

    Article  CAS  PubMed  Google Scholar 

  3. Haricharan RN, Seo JM, Kelly DR et al (2008) Older age at diagnosis of Hirschsprung disease decreases risk of postoperative enterocolitis, but resection of additional ganglionated bowel does not. J Pediatr Surg 43:1115–1123. https://doi.org/10.1016/j.jpedsurg.2008.02.039

    Article  PubMed  Google Scholar 

  4. Le-Nguyen A, Righini-Grunder F, Piché N et al (2019) Factors influencing the incidence of Hirschsprung associated enterocolitis (HAEC). J Pediatr Surg 54:959–963. https://doi.org/10.1016/j.jpedsurg.2019.01.026

    Article  PubMed  Google Scholar 

  5. Chung PHY, Yu MON, Wong KKY, Tam PKH (2019) Risk factors for the development of post-operative enterocolitis in short segment Hirschsprung’s disease. Pediatr Surg Int 35:187–191. https://doi.org/10.1007/s00383-018-4393-3

    Article  PubMed  Google Scholar 

  6. Hackam DJ, Filler RM, Pearl RH (1998) Enterocolitis after the surgical treatment of Hirschsprung’s disease: risk factors and financial impact. J Pediatr Surg 33:830–833. https://doi.org/10.1016/S0022-3468(98)90652-2

    Article  CAS  PubMed  Google Scholar 

  7. Prato AP, Gentilino V, Giunta C et al (2008) Hirschsprung disease: do risk factors of poor surgical outcome exist? J Pediatr Surg 43:612–619. https://doi.org/10.1016/j.jpedsurg.2007.10.007

    Article  Google Scholar 

  8. Huang WK, Li XL, Zhang J, Zhang SC (2018) Prevalence, risk factors, and prognosis of postoperative complications after surgery for Hirschsprung disease. J Gastrointest Surg 22:335–343. https://doi.org/10.1007/s11605-017-3596-6

    Article  PubMed  Google Scholar 

  9. Parahita IG, Makhmudi A (2018) Comparison of Hirschsprung-associated enterocolitis following Soave and Duhamel procedures. J Pediatr Surg 53:1351–1354. https://doi.org/10.1016/j.jpedsurg.2017.07.010

    Article  PubMed  Google Scholar 

  10. Friedmacher F, Puri P (2013) Hirschsprung’s disease associated with Down syndrome: a meta-analysis of incidence, functional outcomes and mortality. Pediatr Surg Int 29:937–946. https://doi.org/10.1007/s00383-013-3361-1

    Article  PubMed  Google Scholar 

  11. Kwendakwema N, Al-Dulaimi R, Presson AP et al (2016) Enterocolitis and bowel function in children with Hirschsprung disease and trisomy 21. J Pediatr Surg 51:2001–2004. https://doi.org/10.1016/j.jpedsurg.2016.09.026

    Article  PubMed  Google Scholar 

  12. Wang X, Li Z, Xu Z et al (2014) Probiotics prevent Hirschsprung’s disease-associated enterocolitis: a prospective multicenter randomized controlled trial. Int J Colorectal Dis 30:105–110. https://doi.org/10.1007/s00384-014-2054-0

    Article  CAS  PubMed  Google Scholar 

  13. El-Sawaf M, Siddiqui S, Mahmoud M et al (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 48:111–117. https://doi.org/10.1016/j.jpedsurg.2012.10.028

    Article  PubMed  Google Scholar 

  14. Suita S, Taguchi T, Ieiri S, Nakatsuji T (2005) Hirschsprung’s disease in Japan: analysis of 3852 patients based on a nationwide survey in 30 years. J Pediatr Surg 40:197–202. https://doi.org/10.1016/j.jpedsurg.2004.09.052

    Article  PubMed  Google Scholar 

  15. Nakamura M, Wada M, Fukuzawa T et al (2019) Treatment of classic-type Hirschsprung’s disease: rectoplasty with posterior triangular colonic flap versus transanal endorectal pull-through with rectoanal myotomy. Pediatr Surg Int 35:203–207. https://doi.org/10.1007/s00383-018-4396-0

    Article  PubMed  Google Scholar 

  16. Frykman PK, Kim S, Wester T et al (2018) Critical evaluation of the Hirschsprung-associated enterocolitis (HAEC) score: a multicenter study of 116 children with Hirschsprung disease. J Pediatr Surg 53:708–717. https://doi.org/10.1016/j.jpedsurg.2017.07.009

    Article  PubMed  Google Scholar 

  17. Menezes M, Puri P (2006) Long-term outcome of patients with enterocolitis complicating Hirschsprung’s disease. Pediatr Surg Int 22:316–318. https://doi.org/10.1007/s00383-006-1639-2

    Article  PubMed  Google Scholar 

  18. Surana R, Quinn FMJ, Puri P (1994) Evaluation of risk factors in the development of enterocolitis complicating Hirschsprung’s disease. Pediatr Surg Int 9:234–236. https://doi.org/10.1007/BF00832245

    Article  Google Scholar 

  19. Gosain A (2016) Established and emerging concepts in Hirschsprung’s-associated enterocolitis. Pediatr Surg Int 32:313–320. https://doi.org/10.1007/s00383-016-3862-9

    Article  PubMed  PubMed Central  Google Scholar 

  20. Prato AP, Bartow-McKenney C, Hudspeth K et al (2019) A metagenomics study on Hirschsprung’s disease associated enterocolitis: biodiversity and gut microbial homeostasis depend on resection length and patient’s clinical history. Front Pediatr 7:1–9. https://doi.org/10.3389/fped.2019.00326

    Article  Google Scholar 

  21. Murphy F, Puri P (2005) New insights into the pathogenesis of Hirschsprung’s associated enterocolitis. Pediatr Surg Int 21:773–779. https://doi.org/10.1007/s00383-005-1551-1

    Article  PubMed  Google Scholar 

  22. Hureibi K, Sunidar OA (2014) Mesenteric cystic lymphangioma mimicking malignancy. BMJ Case Rep. https://doi.org/10.1136/bcr-2014-203560

    Article  PubMed  PubMed Central  Google Scholar 

  23. Cheng Z, Zhao L, Dhall D et al (2018) Bacterial microbiome dynamics in post pull-through Hirschsprung- associated enterocolitis (HAEC): an experimental study employing the endothelin receptor B-null mouse model. Front Surg 5:1–9. https://doi.org/10.3389/fsurg.2018.00030

    Article  Google Scholar 

  24. Soh HJ, Nataraja RM, Pacilli M (2018) Prevention and management of recurrent postoperative Hirschsprung’s disease obstructive symptoms and enterocolitis: systematic review and meta-analysis. J Pediatr Surg 53:2423–2429. https://doi.org/10.1016/j.jpedsurg.2018.08.024

    Article  PubMed  Google Scholar 

  25. Halleran DR, Ahmad H, Maloof E et al (2020) Does Hirschsprung-associated enterocolitis differ in children with and without down syndrome? J Surg Res 245:564–568. https://doi.org/10.1016/j.jss.2019.06.086

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Miyagi Children’s Hospital, Sendai, 989-3126, Japan

    Tsuyoshi Sakurai, Hiromu Tanaka & Naobumi Endo

Authors
  1. Tsuyoshi Sakurai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiromu Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naobumi Endo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Naobumi Endo.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This study was approved by the ethics committee of Miyagi children’s hospital and has, therefore, been performed in accordance with the ethical standards laid down in the Declaration of Helsinki, 1964, and its later amendments.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sakurai, T., Tanaka, H. & Endo, N. Predictive factors for the development of postoperative Hirschsprung-associated enterocolitis in children operated during infancy. Pediatr Surg Int 37, 275–280 (2021). https://doi.org/10.1007/s00383-020-04784-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-020-04784-z

Keywords

Search

Navigation