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Unexpected mortality in pediatric patients with postoperative Hirschsprung's disease
Jin-Sheng Wang1, Hung-Chang Lee, Fu-Yuan Huang
1Department of Pediatrics, Kaohsiung Municipal United Hospital, Taiwan.
Insights
This study on Hirschsprung's disease found anaerobic sepsis, potentially indicated by Thomsen (T-) antigen, caused deaths in pediatric patients post-surgery. Early detection and anti-anaerobic treatment are recommended.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Infectious Diseases
Background:
- Hirschsprung's disease is a congenital condition causing lower intestinal obstruction in pediatric patients.
- Postoperative complications, particularly enterocolitis and sepsis, remain significant concerns following surgical correction.
Purpose of the Study:
- To investigate postoperative complications and causes of death in pediatric patients with Hirschsprung's disease.
- To identify potential markers and contributing factors for fatal outcomes, specifically anaerobic sepsis.
Main Methods:
- Retrospective analysis of 147 pediatric patients undergoing surgical intervention for Hirschsprung's disease between 1981 and 1998.
- Pathological confirmation of aganglionosis extent and clinical assessment of postoperative enterocolitis and sepsis.
- Investigation of Thomsen (T-) antigen status in deceased patients.
Main Results:
- Five patients died post-surgery, with anaerobic sepsis identified as the primary cause.
- All five deceased patients tested positive for Thomsen (T-) antigen.
- Recurrent Hirschsprung's enterocolitis was observed in some patients.
Conclusions:
- Thomsen (T-) antigen may serve as a useful marker for anaerobic bacterial infections in patients with Hirschsprung's disease.
- Prompt administration of empirical antibiotics with anti-anaerobic activity is crucial for managing sepsis.
- Colon irrigation should be considered for patients developing sepsis post-pull-through procedures.
Abstract:
Hirschsprung's disease is characterized by lower intestinal obstruction. In this retrospective study, we investigated the postoperative complications and the causes of death in pediatric patients with Hirschsprung's disease. Between January 1981 and June 1998, 147 patients with Hirschsprung's disease underwent surgical intervention (129 with both colostomy and Soave's pull-through procedures) at Mackay Hospital. Of 147 total patients, 83.67% had aganglionosis in the rectosigmoid, 5.44% had colon involvement, and 4.08% had total colon aganglionosis, documented pathologically after a Soave's pull-through procedure. Any post-pull-through patient who showed symptoms of fever, leukocytosis, diarrhea, and clinical sepsis was diagnosed with Hirschsprung's enterocolitis. Four patients died within 4.5 months of surgery, and one patient died more than 4 years after surgery; these five patients were positive for Thomsen (T-) antigen. One patient died soon after rectal irrigation was performed in preparation for the surgery. All five of these patients had sepsis clinically, and anaerobic sepsis was attributed as the main cause of their deaths. Of interest in these cases is the presence of T-antigen, a potentially useful marker for anaerobic bacterial infection that may not be well known to most pediatricians. We recommend (1) determining the presence of T-antigen in patients with recurrent Hirschsprung's enterocolitis, (2) administering empirical antibiotics with anti-anaerobic activity as soon as possible, and (3) irrigating the colon in those patients who develop sepsis after a pull-through procedure.