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Pseudomembranous colitis following resection for Hirschsprung's disease
C E Bagwell1, M R Langham, S M Mahaffey
1Division of Pediatric Surgery, University of Florida College of Medicine, Gainesville 32610-0286.
Journal of Pediatric Surgery
|October 11, 1992
Summary
Pseudomembranous colitis (PMC) can be a severe complication after Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Infectious Diseases
Background:
- Hirschsprung's disease is a congenital condition characterized by the absence of ganglion cells in the colon, leading to functional obstruction.
- Enterocolitis is a serious complication of Hirschsprung's disease, often associated with significant morbidity and mortality.
- Pseudomembranous colitis (PMC) is a severe form of enterocolitis that can occur postoperatively.
Observation:
- Four cases of PMC developing 1-18 months after definitive surgery for Hirschsprung's disease are reported.
- Patients presented with symptoms indistinguishable from typical Hirschsprung's enterocolitis, including fever, abdominal distention, and diarrhea.
- Two cases had a fulminant course, resulting in death from septic shock, despite vancomycin therapy.
Findings:
- Extensive colonic pseudomembranes were observed in postmortem examinations.
- Clostridium difficile toxin was identified in all cases, but treatment was often initiated late.
- Two survivors required prolonged hospitalization and diverting enterostomy due to the severity of PMC.
Implications:
- PMC is a virulent complication of Hirschsprung's disease, even after surgical correction.
- Early detection and prompt treatment of C. difficile are crucial for improving outcomes.
- Prophylactic or early empiric vancomycin treatment for Hirschsprung's enterocolitis is recommended due to high associated risks.