Hirschsprung-associated enterocolitis: pathogenesis, treatment and prevention

被引:0
作者
Farokh R. Demehri
Ihab F. Halaweish
Arnold G. Coran
Daniel H. Teitelbaum
机构
[1] University of Michigan Health System,Section of Pediatric Surgery, C.S. Mott Children’s Hospital
[2] University of Michigan Medical School,undefined
来源
Pediatric Surgery International | 2013年 / 29卷
关键词
Hirschsprung disease; Enterocolitis; HAEC; Pathogenesis; Prevention; Treatment;
D O I
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中图分类号
学科分类号
摘要
Hirschsprung-associated enterocolitis (HAEC) is a common and sometimes life-threatening complication of Hirschsprung disease (HD). Presenting either before or after definitive surgery for HD, HAEC may manifest clinically as abdominal distension and explosive diarrhea, along with emesis, fever, lethargy, and even shock. The pathogenesis of HAEC, the subject of ongoing research, likely involves a complex interplay between a dysfunctional enteric nervous system, abnormal mucin production, insufficient immunoglobulin secretion, and unbalanced intestinal microflora. Early recognition of HAEC and preventative practices, such as rectal washouts following a pull-through, can lead to improved outcomes. Treatment strategies for acute HAEC include timely resuscitation, colonic decompression, and antibiotics. Recurrent or persistent HAEC requires evaluation for mechanical obstruction or residual aganglionosis, and may require surgical treatment with posterior myotomy/myectomy or redo pull-through. This chapter describes the incidence, pathogenesis, treatment, and preventative strategies in management of HAEC.
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页码:873 / 881
页数:8
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[1]  
Aslam A(1998)Turnover of radioactive mucin precursors in the colon of patients with Hirschsprung’s disease correlates with the development of enterocolitis J Pediatr Surg 33 103-105
[2]  
Spicer RD(1999)Histochemical and genetic analysis of colonic mucin glycoproteins in Hirschsprung’s disease J Pediatr Surg 34 330-333
[3]  
Aslam A(2012)The pathogenesis of Hirschsprung’s disease-associated enterocolitis Semin Pediatr Surg 21 319-327
[4]  
Spicer RD(1992)Pseudomembranous colitis following resection for Hirschsprung’s disease J Pediatr Surg 27 1261-1264
[5]  
Austin KM(1962)The enterocolitis of Hirschsprung’s disease: its natural history and treatment Am J Surg 103 70-74
[6]  
Bagwell CE(1989)The piebald-lethal murine strain: investigation of the cause of early death J Pediatr Surg 24 906-910
[7]  
Langham M(2000)Recent advances in the management of Hirschsprung’s disease Am J Surg 180 382-387
[8]  
Bill J(2010)Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa Proc Natl Acad Sci USA 107 14691-14696
[9]  
Chapman AH(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
[10]  
Chapman ND(1995)Enterocolitis associated with Hirschsprung’s disease: a clinical-radiological characterization based on 168 patients J Pediatr Surg 30 76-83