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Pathologically assessed grade of Hirschsprung-associated enterocolitis in resected colon in children with
Siyang Cheng1, Jun Wang1, Weihua Pan1
1Department of Pediatric Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China; Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, No. 1665, Kongjiang Road, Shanghai, 200092, China.
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Pathological enterocolitis grade in resected colon impacts bowel function recovery in children with Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pathology
Background:
- Hirschsprung's disease (HD) is a congenital condition affecting the large intestine.
- Hirschsprung-associated enterocolitis (HAEC) is a serious complication following HD surgery.
- Assessing pathological findings of resected colon is crucial for understanding postoperative outcomes.
Purpose of the Study:
- To investigate the correlation between the pathological grade of enterocolitis in resected colon specimens and postoperative bowel function in children with HD.
- To identify specific pathological features predictive of poor bowel function recovery after HD surgery.
Main Methods:
- A cohort of 80 children with HD undergoing resection between 2012 and 2013 was studied.
- Resected colon specimens were histopathologically graded for HAEC.
- Postoperative bowel function, including time to normal defecation and HAEC readmissions, was assessed.
- Statistical analyses included t-tests, ANOVA, Kaplan-Meier, and regression models.
Main Results:
- Children with inflamed proximal colon segments had a 1.5-fold higher risk of poor recovery.
- Each grade increase in HAEC of the transitional and overall segments correlated with increased postoperative HAEC admissions.
- Grade ≥3 HAEC in the transitional segment significantly increased the incidence of postoperative HAEC by 4.75-fold.
Conclusions:
- Inflammation in the resected proximal colon is a risk factor for poor surgical recovery in HD.
- Higher overall pathological HAEC scores indicate an increased risk of subsequent enterocolitis.
- The severity of enterocolitis in the transitional segment is the most significant predictor of postoperative HAEC.
Purpose:
The aim of this study was to investigate the relationship between the grade of enterocolitis on pathological assessment of resected colon and postoperative bowel function in children with Hirschsprung's disease (HD).
Methods:
Children with HD who were seen at a large tertiary center from January 2012 to December 2013 were enrolled into this study. Resected colon was assessed using the histopathologic grade scoring system for Hirschsprung-associated enterocolitis (HAEC), and the relationship of these scores to postoperative bowel function was assessed. Time of recovery to normal defecation was the primary outcome measure. The t-test, analysis of variance, and Kaplan-Meier, univariate, and multiple regression analyses were performed.
Results:
Eighty children with HD (median age at repair 7.9months; range 1.3months to 9years) were included in the study. Nineteen children dropped out of the study and were considered as providing censored data, giving a follow-up rate of 76.3%. A total of 21 children (34.4%) were admitted to hospital with at least one episode of enterocolitis. Multivariate Cox proportional hazards models showed that compared with patients with a normal proximal colon, those with an inflamed proximal segment had a 1.5-fold higher risk of a poor recovery. Logistic regression analyses suggested that postoperative HAEC admissions increased by 57% with each HAEC pathological grade of the transitional segment and by 50% with each grade of the overall segment. Compared with normal bowel in the transitional segment, the detection of grade ≥3 HAEC in the transitional area increased the incidence of postoperative HAEC by 4.75-fold.
Conclusions:
Children whose resected proximal colon showed inflammation on pathological assessment were at risk of poor recovery after surgery. A higher pathological HAEC score for the sum of the overall three segments suggested an increased risk for the subsequent development of enterocolitis. Among three segments, the severity of enterocolitis in the transitional segment was the most significant factor in predicting postoperative HAEC.
Type Of Study:
Clinical study.
Level Of Evidence:
Moderate.