Predictive Factors for Hirschsprung-Associated Enterocolitis in Pediatric Patients

B Aziza, Y Houas, N Ben Alaya, S Fkaier, F Thamri, A Guitouni, Y Kerkeni, S Sahli, R Jouini

children hospital Bechir Hamza, Pediatric surgery department A Tunis Tunisia

Introduction :

Hirschsprung-associated enterocolitis (HAEC) is a serious complication in children with Hirschsprung disease (HD) which poses a substantial risk of morbidity and mortality.

Aim of the study:

To identify the predictive factors for HAEC in pediatric patients with HD.

Materials and Methods

We conducted a retrospective review of medical records of children diagnosed with HD from January 2000 to December 2024. Data were analyzed to determine the incidence of enterocolitis and associated factors, including age at diagnosis, disease extent, surgical intervention details, the presence of associated congenital anomalies, preoperative enterocolitis episodes, and postoperative complications.

Results

Seventy-eight patients with HD were included, with a mean age at diagnosis of 8 months (range: 5 days to 12 years). The incidence of HAEC increased from 9% in the first week of life to 20% thereafter. Thirty-five (44.8%) underwent primary pull-through surgery at a median age of 1 month. The remaining 43 patients (55.3%) who initially had an ostomy had their intestinal continuity restored at a median of 98 days. There was no increase in HAEC incidence following primary pull-through without stoma formation. Overall, 39 patients (50%) experienced at least one episode of HAEC, with 17 patients (22%) having multiple episodes (p=0.032). Patients with extensive disease, defined as long-segment involvement (≥ 20 cm), had a significantly higher rate of HAEC compared to those with less extensive disease (89% vs. 44%, p< 0.001). HAEC was also notably associated with delayed initial surgery (≥ 6 months after diagnosis; p = 0.004) and postoperative complications such as anastomotic stricture (p < 0.01).

Conclusion

This study highlights several key predictive factors for the development of HAEC including disease extent, timing of diagnosis and surgery, and postoperative complications. Recognizing these factors early can guide targeted management strategies to prevent HAEC and enhance patient outcomes.

Keywords: hirschsprung, enterocolitis, surgery

Pediatrik Hastalarda Hirschsprung ile İlişkili Enterokolit için Prediktif Faktörler

B Aziza, Y Houas, N Ben Alaya, S Fkaier, F Thamri, A Guitouni, Y Kerkeni, S Sahli, R Jouini

Bechir Hamza Çocuk Hastanesi Çocuk Cerrahisi Bölümü A

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