scholarly journals Colonoscopic Diagnosis of Postoperative Gastrointestinal Bleeding in Patients With Hirschsprung's Disease

2021 ◽  
Vol 9 ◽  
Author(s):  
Jixin Yang ◽  
Tianqi Zhu ◽  
Xiaojuan Wu ◽  
Mingfa Wei ◽  
Guo Wang ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Lower Gastrointestinal Bleeding ◽  
Pathological Diagnosis ◽  
Uneventful Recovery ◽  
Saline Irrigation ◽  
Specific Symptom ◽  
Significant Difference ◽  
The Mean

Aim: Postoperative lower gastrointestinal bleeding in children with Hirschsprung's Disease (HSCR) is a non-specific symptom, which may be caused by various etiologies. Our current study aims to utilize colonoscopy to diagnose the causes of postoperative hematochezia and to analyze its feasibility, accuracy, and safety.Methods: Twenty-four patients with HSCR with postoperative lower gastrointestinal bleeding or occult blood in the stool were enrolled in this study. The postoperative onset duration, age at examination, accompanied anomalies were recorded. After bowel preparation, all patients underwent colonoscopy. According to visual findings, mucosal biopsy was performed, followed by pathological diagnosis. Further treatment was determined according to the visual findings and pathological diagnosis. All patients were followed up for 6 months including therapeutic outcomes and recurrence of symptoms.Results: The mean onset duration was (221.3 ± 216.8) days postoperatively (ranging from 25 to 768 days). The mean age at examination was (41.0 ± 29.4) months. There was no significant difference in the onset days among each group (all, p > 0.05). Based on visual and pathological findings, there were 11 cases of HSCR associated enterocolitis (HAEC), 4 cases of anastomotic leakage, 7 cases of anastomotic inflammation, 1 case of juvenile polyp, and 1 case of inflammatory pseudopolyp. Intraluminal saline irrigation, thrombin treatment or colorectal polyp electrocision was performed according to intraoperative diagnosis. Patients with HEAC and anastomotic inflammation underwent antibiotics therapy and colorectal irrigation. Patients with leakage underwent reoperation. The highest incidence of accompanied symptoms of diarrhea existed in HEAC group (p = 0.02) and fever in leakage group (p = 0.02), respectively. No perforation or aggravated bleeding occurs in any patients. All patients gained uneventful recovery during follow-up period.Conclusions: Colonoscopy is a safe, accurate and timely examination for HSCR patients with postoperative lower gastrointestinal bleeding. The visual findings and biopsy may provide accurate diagnosis and guide treatment for this subset of patients.

scholarly journals The follow-up of the robotic-assisted Soave procedure for Hirschsprung’s disease in children

2021 ◽  
Author(s):  
Tran Anh Quynh ◽  
Pham Duy Hien ◽  
Le Quang Du ◽  
Le Hoang Long ◽  
Nguyen Thi Ngoc Tran ◽  
...  
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Pediatric Patients ◽  
Three Dimensional ◽  
Dentate Line ◽  
Robotic Arms ◽  
Robotic Assisted ◽  
The Mean ◽  
Pull Through

AbstractRobotic surgery offers three-dimensional visualization and precision of movement that could be of great value to gastrointestinal surgeons. There were many previous reports on robotic technology in performing Soave colonic resection and pull-through for Hirschsprung’s disease in children. This study described the follow-up of the Robotic-assisted Soave procedure for Hirschsprung’s disease in children. Robotic-assisted endorectal pull-through was performed using three robotic arms and an additional 5-mm trocar. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies. The rest of the procedure was carried out according to the Soave procedure. We left a short rectal seromuscular sleeve of 1.5–2 cm above the dentate line. From December 2014 to December 2017, 55 pediatric patients were operated on. Age ranged from 6 months to 10 years old (median = 24.5 months). The aganglionic segment was located in the rectum (n = 38), the sigmoid colon (n = 13), and the left colon (n = 4). The mean total operative time was 93.2 ± 35 min (ranging from 80 to 180 min). Minimal blood was lost during the surgery. During the follow-up period, 41 patients (74.6%) had 1–2 defecations per day, 12 patients (21.8%) had 3–4 defecations per day, and 2 patients (3.6%) had more than 4 defecations per day. Fecal incontinence, enterocolitis, and mild soiling occurred in three (5.4%), four (7.3%), and two pediatric patients, respectively. Robotic-assisted Soave procedure for Hirschsprung’s disease in children is a safe and effective technique. However, a skilled robotic surgical team and procedural modifications are needed.

scholarly journals Is There Pathological Uniformity between the Periphery and Center of a Gastrointestinal Stromal Tumor?

2021 ◽  
Vol 10 (4) ◽  
pp. 687
Author(s):  
Seong Ji Choi ◽  
Kwan Hong Lee ◽  
Chan Kyoo Yoo ◽  
Jai Hoon Yoon ◽  
Ki Seok Jang ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Mitotic Index ◽  
High Power ◽  
Malignant Potential ◽  
Mitotic Count ◽  
Pathological Diagnosis ◽  
High Power Field ◽  
Gastric Gists ◽  
Significant Difference ◽  
The Mean

Background: Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors and have some malignant potential. Mitotic count is important for predicting the malignant potential of GISTs. Proper treatment of GISTs requires accurate pathological diagnosis. In general, endoscopic ultrasound-guided fine-needle aspiration and deep biopsy are used for pathological diagnosis of GIST before making decisions about surgery. This study sought to evaluate the pathological uniformity of gastric GISTs for mitotic index of the center and periphery of the GIST. Methods: We retrospectively reviewed the data of 37 gastric GIST patients who underwent wedge resection at Hanyang University Hospital. We used Armed Forces Institute of Pathology criteria to classify gastric GISTs. To determine the pathological uniformity of gastric GISTs, we compared GIST risk stratification between the center and periphery of GISTs. Results: The mean size of GISTs was 3.56 ± 2.10 cm. Three lesions were located in the antrum, 11 in the fundus, 9 in the cardia, and 14 in the body. The mean age of patients was 58.65 ± 9.44 years; 18 patients were male and 19 were female. Thirty-five patients (94.6%) showed the same level of risk stratification between the center and periphery of gastric GISTs, while two patients (5.4%) presented different levels of risk between the two sites. No significant difference in mitotic count was observed between the two sites (kappa value = 0.863; p = 0.001). Conclusions: Mitotic index category (either more than five mitoses per high-power field or five or fewer mitoses per high-power field) of GISTs showed good concurrence between the center and periphery.

scholarly journals Early and long-term complications following transanal pull through Soave technique in infants with Hirschsprung's diseaseric infants with Hirschsprung's disease

2019 ◽  
Author(s):  
Manoochehr Ghorbanpour ◽  
Mohammad Ali Seyfrabie ◽  
Babak Yousefi
Keyword(s):  
Intestinal Obstruction ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Statistical Tests ◽  
Case Series ◽  
P Value ◽  
Short Term ◽  
Case Series Study ◽  
The Mean

Objective. Patients undergoing Soave surgery for Hirschsprung's disease are at risk for some complications. The aim of this study was to investigate such short-term and long-term complications and evaluate the outcome of the operation in these patients. Methods. A case series study was carried out during the last 12 years, during 2007 to 2018 in Besat hospital of Hamadan. Data collection conducted using a checklist includes questions about demographic information, clinical features, and short-term and long-term complications, and consequences of post-operative surgery. The findings of the study were analyzed using SPSS software version 20 and appropriate statistical tests. P-value less than 0.05 was considered statistically significant. Results. A total of 55 children underwent Soave surgery during the last 12 years in Besat Hospital Hamadan, Iran. The mean age of the patients was 38±10 days during surgery, of which 56.4% were female. The mean hospital stay was 7.3 days. Also, the mean weight of children at birth was 2970±447 gr. Most of the patients were born as NVD (52.7%) and term (74.5%). The most common comorbidity was congenital heart disease. The most common short-term complication was intestinal obstruction in 14 patients (25.5%) and the most frequent long-term complication was intestinal obstruction and constipation (27.3% each cases). The mortality rate of patients in this study was 14.5% in total. Conclusions. One stage surgical procedure in Hirschsprung's disease is a safe and effective method, but care should be taken in choosing patients and patients should be monitored for possible complications, so that they can be considered and implemented for proper treatment.

Outcomes of Primary versus Multiple-Staged Repair in Hirschsprung's Disease in England

2020 ◽  
Vol 30 (01) ◽  
pp. 104-110
Author(s):  
Stefano Giuliani ◽  
Kate Honeyford ◽  
Chieh-Yu Chang ◽  
Alex Bottle ◽  
Paul Aylin
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Primary Repair ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Administrative Database ◽  
Lower Probability ◽  
Significant Difference ◽  
Pull Through ◽  
One Year

Abstract Introduction The study aimed to compare 1-year outcomes for primary versus multiple-staged (three operations with colostomy) repairs in Hirschsprung's disease (HD). Materials and Methods Retrospective analysis of a large national administrative database (Hospital Episode Statistics) including all the neonates born with HD in England between 2003 and 2015. Main outcomes were: 1-year mortality, postoperative readmissions, and reoperations. Secondary outcomes: cumulative length of hospital stay (cLOS) and hospital volume–outcome relationship. Results A total of 1,333 neonates with HD were treated in 21 specialist pediatric surgical centers; 874 (65.5%) patients had a primary repair for HD. One-year mortality was 2.8%. The overall readmission rate was 70.2%, with a significant difference between primary and multiple-staged repair (79.9 vs. 90.1%, p < 0.01). There was no difference in reoperation. Primary pull-through was associated with a significantly lower probability of postoperative readmission (odds ratio [OR] = 0.08, 95% confidence interval [CI] = 0.06–0.11, p < 0.001) and cLOS (OR = 0.38, 95% CI = 0.28–0.52, p < 0.001) compared with multiple-staged repair. There were no significant difference in outcomes between patients treated in low-volume (<37 cases/year) and high-volume (> 55 cases/year) specialist centers. Conclusion Whenever clinically indicated, primary repair should be used in HD as this is associated with fewer readmissions and shorter time spent in the hospital.

scholarly journals Anorectal Manometry on Children: A Moroccan Series and Literature Review

2021 ◽  
Vol 9 (B) ◽  
pp. 337-343
Author(s):  
HANANE DELSA ◽  
Ilham Serraj ◽  
Mohamed Khalis ◽  
Nawal Kabbaj
Keyword(s):  
Statistical Analysis ◽  
Fecal Incontinence ◽  
Gold Standard ◽  
Chronic Constipation ◽  
Anorectal Manometry ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Biofeedback Therapy ◽  
Significant Difference ◽  
Resting Pressure

Introduction and objectives: Anorectal manometry is a test that evaluates the function of the rectum,but also the anus. It is useful for the diagnosis of several conditions like fecal incontinence and constipation.In children these tests are being increasingly used for all ages.The aim of this study was to determine the benefit of anorectal manometry in children and to report our experience. Material and Methods:Over a period of four years, 273children that underwent anorectal manometry were included in the study,their data and tests results were analyzed. Results:Out of 273 patients included,68,5% were boys and 31,5% were girls.The mean age was 9 years.154patients(51,6%) had Fecal incontinence(Group1),75children(27,5%) had chronic constipation(Group2),and both of them(Group3) were reported in 37children(13,6%).An awake manometry was  performed in 248children(91%) however this test under sedation allowed us the exclusion of Hirschsprung’s disease in 21children(84%).In group1, 25%patients had bad anal contraction.In groupe3, 21,6%children had bad anal contraction.The statistical analysis showed a significant difference in age(p=0.022) and resting pressure(p=0.050) between the three groups.Children with fecal incontinence had a higher rate of dyssynergy,80.2% and 83.8% in groups 1 and 3 respectively compared to 60.4% in patients with chronic constipation(p=0,852) Conclusion:The gold standard for the exploration of children’s terminal constipation and encopresis is the anorectal manometry.It is an important tool to establish diagnosis.In our study, this test allow the exclusion of Hirschsprung’s disease in infants with constipation,  in other hand we found a higher rate of dyssynergy in children with fecal incontinence(80%) which had allow us to propose a biofeedback therapy.

Idiopathic Megacolon in an Adolescent Girl: a Case Report on a Rare Disease

2021 ◽  
Author(s):  
Sharhanin Bahrudin ◽  
Abdul Malek Moahamd ◽  
Azmi Mohd Nor ◽  
Faisal Elagili
Keyword(s):  
Abdominal Pain ◽  
Success Rate ◽  
Rare Disease ◽  
Adolescent Girl ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Sigmoid Volvulus ◽  
Uneventful Recovery ◽  
Idiopathic Megacolon ◽  
Segmental Colectomy

Abstract Introduction: Idiopathic Megacolon is a rare condition where there is persistent dilatation of colon in the absence of identifiable cause. Symptoms start as early as in childhood or in adulthood. Colectomy have shown to have high success rate in patient with idiopathic megacolon. We reported a case of an adolescent girl with idiopathic megacolon that was successfully treated with colectomy.Presentation of case: A 15 years old girl presented with a complaint of abdominal pain associated with gradual abdominal distension for 1 week duration, not passing flatus and had multiple episodes of vomiting. She was diagnosed to have sigmoid volvulus and underwent endoscopy decompression, however symptoms recurred. Segmental colectomy was performed and she had an uneventful recovery. Discussion: Patient presented with acute intestinal obstruction attributed to sigmoid volvulus with a history of constipation. A diagnostic dilemma between Hirschsprung’s disease with other causes of megacolon occurred as these diseases have similar presenting symptoms. A confirm histopathology of presence of ganglionic cells within the plexus exclude the diagnosis of Hirschsprung’s disease hence the diagnosis of Idiopathic Megacolon was made. Segmental colectomy give good result in relieving patient symptoms of abdominal pain and constipation and one of the recommended surgical options in treating Idiopathic Megacolon.Conclusion: Idiopathic megacolon is a rare disease and for a long time has been a disease of exclusion. Rectal biopsy is important to exclude the diagnosis of Hirschsprung’s Disease. There are wide variety of surgical treatment available in treating Idiopathic megacolon. Segmental Colectomy have shown good success rate.

Internal Iliac Aneurysm Rupture into the Rectum following Endovascular Exclusion: An Unusual Cause of Massive Lower Gastrointestinal Bleeding

2002 ◽  
Vol 9 (6) ◽  
pp. 907-911 ◽  
Author(s):  
Christos D. Karkos ◽  
Taohid O. Oshodi ◽  
Dale Vimalachandran ◽  
John S. Abraham ◽  
Mohan Adiseshiah
Keyword(s):  
Gastrointestinal Bleeding ◽  
Iliac Artery ◽  
Aneurysm Rupture ◽  
Lower Gastrointestinal Bleeding ◽  
Uneventful Recovery ◽  
Intestinal Bleeding ◽  
Iliac Aneurysm ◽  
Stent Grafting ◽  
Internal Iliac ◽  
Internal Iliac Aneurysm

Purpose: To report a rare iliorectal fistula following endovascular treatment of an internal iliac aneurysm. Case Report: A 76-year-old man developed lower gastrointestinal bleeding 3 months after successful endovascular exclusion of a left internal iliac aneurysm with coil embolization, attempted stent-grafting, ligation of the distal external iliac artery, and a femorofemoral crossover bypass. Aortography showed no clear intestinal bleeding point, but demonstrated recanalization and continued perfusion of the aneurysm. At laparotomy, an iliorectal fistula was detected. The common iliac artery was ligated proximally, the aneurysm sac was opened, and the back-bleeding internal iliac artery branches were oversewn. The rectum was closed primarily. He made an uneventful recovery. Conclusions: An iliorectal fistula is an extremely rare and unlikely complication of coil occlusion of an iliac aneurysm. A high index of suspicion for the diagnosis is of paramount importance. Periodic imaging in these patients is required to detect recanalization and continuing aneurysm expansion.

Mechanical Bowel Preparation versus No Preparation in Duhamel Procedure in Children with Hirschsprung's Disease

2019 ◽  
Vol 30 (02) ◽  
pp. 201-204
Author(s):  
Mehrdad Hosseinpour ◽  
Bahareh Ahmadi ◽  
Sanaz Etezazian
Keyword(s):  
Randomized Controlled Trial ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Controlled Trial ◽  
Control Group ◽  
Complication Rates ◽  
Randomized Controlled ◽  
Rectal Washout ◽  
Significant Difference ◽  
Duhamel Procedure

Abstract Introduction Mechanical bowel prep (MBP) prior to surgical treatment of Hirschsprung's disease (HSCR) has been a great problem of pediatric surgeons for a long time. We conducted a single-institution randomized controlled trial to evaluate the efficacy of no MBP in children with HSCR undergoing the Duhamel procedure. Materials and Methods In this study, children with HSCR who were candidate for the Duhamel procedure were included (40 cases vs. 40 controls). In the case group, intraoperatively after transection of the bowel at the level of transitional zone, feces bulk was pulled up from the upper part of the rectum to the sigmoid colon above the peritoneal reflection and aganglionic bowel was resected. Inspissated stool in the distal of the rectum was removed by rectal washout intraoperatively. In the control group, routine MBP was performed. Cleanness of the rectum was evaluated intraoperatively. Results In this study, a total of 80 children were enrolled. In 32 patients (80%), the goal of MPB was achieved in 4 hours. Mean polyethylene glycol volume was 1372.3 ± 231.9 mL. Preoperative rectal washout fluid was 635 ± 233.3 mL. There was no statistically significant difference in individual complication rates between groups. Four patients (5%) had intra-abdominal infection and 16 (20%) had wound infection. We had no anastomotic leak in our groups. All children or parents in the control group described the preoperative MBP as the most unpleasant part of the hospital administration. Conclusion For young children with HSCR who were scheduled for Duhamel operation, we had found no clear benefit of MBP. However, a multicenter randomized controlled trial is needed to more definitely determine the best preoperative approach for children with HSCR.

scholarly journals Prospective comparison of chilled versus room temperature saline irrigation in alcohol-assisted photorefractive keratectomy

2013 ◽  
Vol 5 (2) ◽  
pp. 154-160 ◽  
Author(s):  
Marcus C Neuffer ◽  
YM Khalifa ◽  
M Moshirfar ◽  
MD Mifflin
Keyword(s):  
Ocular Surface ◽  
Room Temperature ◽  
Photorefractive Keratectomy ◽  
Spherical Equivalent ◽  
Saline Irrigation ◽  
Prospective Comparison ◽  
Significant Difference ◽  
Manifest Refraction ◽  
The Mean ◽  
Contralateral Eye

Introduction: Chilled saline is commonly used to irrigate the ocular surface after photorefractive keratectomy (PRK) and is often considered by the patients to be uncomfortable. Room temperature (non-chilled) saline may be a safe and less painful alternative. Objectives: To compare pain and visual outcomes after irrigating the ocular surface with chilled saline versus room temperature saline in alcohol assisted PRK. Materials and methods: In this prospective, single-masked, randomized, contralateral eye study, myopic eyes were treated with PRK. Immediately after laser ablation one eye was irrigated with chilled saline and the other with non-chilled saline. Primary outcomes measured were pain, haze, uncorrected (UCVA) and best-corrected (BCVA) visual acuities, and manifest refraction. Results: Each group comprised of 40 eyes. There was no significant difference in pain between the groups at any point during five days after surgery. At 6 months the mean UCVA was -0.08 logMAR ± .077 [SD] (20/17) and -0.07 ± .074 logMAR (20/17) in the chilled and non-chilled groups respectively (p =.35). Both groups achieved 95% UCVA of 20/20 or better. The manifest refraction spherical equivalent (MRSE) was -0.05 ± 0.21 D and -0.025 ± 0.27 D respectively (p = .79). There were no lines lost of BCVA and no haze observed. Similar outcomes were observed with regard to pain and vision in both groups. Conclusion: The use of room temperature saline irrigation during PRK appears to be safe and effective. Nepal J Ophthalmol 2013; 5(10): 154-160 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8706

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