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Defecation Disorders in Children After Surgery for Hirschsprung Disease

Chumpitazi, Bruno P; Nurko, Samuel

Journal of Pediatric Gastroenterology & Nutrition: July 2011 - Volume 53 - Issue 1 - p 75–79
doi: 10.1097/MPG.0b013e318212eb53
Original Articles: Gastroenterology

Background and Objective: The majority of children with Hirschsprung disease (HD) after corrective surgery (CS) develop protracted defecation disorders (DDs) such as constipation, fecal incontinence, and/or enterocolitis. The aim of this investigation was to determine the diagnoses, therapies, and long-term clinical outcomes using a systematic algorithm to address protracted DD in children with HD after CS.

Methods: Retrospective review of children with HD after CS cared for using a systematic algorithm at a tertiary care center. Potential anatomic etiologies were evaluated for first. Clinical outcome was categorized into 4 groups based on symptom severity, time interval from last enterocolitis episode, laxative usage, and/or rectal therapies at the time of last follow-up.

Results: Fifty-seven children were identified, of whom 51 (89.5%) had obstructive symptoms and/or enterocolitis and 6 (10.5%) had nonretentive fecal incontinence. Nonintractable constipation responsive to laxatives was identified in 10 (17.5%), colonic dysmotility in 4 (7.0%), nonrelaxing anal sphincter as a primary etiology in 22 (38.6%), bacterial overgrowth in 2 (3.5%), food intolerance in 2 (3.5%), and rapid transit in 2 (3.5%). Further surgical intervention was undertaken in 22 (38.6%), including 9 (15.8%) for residual aganglionosis. Mean follow-up was 41.4 ± 4.5 months. Clinical outcomes were excellent in 16 (28.1%), good in 22 (38.6%), fair in 1 (1.8%), and poor in 18 (31.6%). Children with enterocolitis were more likely to have an excellent or good clinical outcome.

Conclusions: The majority of children with HD and protracted DD after CS have a favorable long-term clinical outcome when following a systematic algorithm.

Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, Boston, MA.

Received 7 November, 2010

Accepted 17 January, 2011

Address correspondence and reprint requests to Samuel Nurko, MD, MPH, Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (e-mail: Samuel.nurko@childrens.harvard.edu).

(B.C. present affiliation: Texas Children's Hospital Neurogastroenterology and Motility Program, Baylor College of Medicine, Houston.)

The present study was supported in part by NIH grant K24-DK082792A (Dr Nurko), the Children's Digestive Health and Nutrition Foundation/Nestle Nutrition Research Young Investigator Award (Dr Chumpitazi), and NIH grant P30-DK056338 (Dr Chumpitazi).

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN