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Unexpected death from enterocolitis after surgery for Hirschsprung's disease
T L Marty1, M E Matlak, M Hendrickson
1Department of Surgery, University of Utah, Salt Lake City 84113-1100, USA.
Insights
Fatal postoperative enterocolitis can occur unexpectedly in children after Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Medicine
Background:
- Hirschsprung's disease is a congenital condition requiring surgical reconstruction.
- Enterocolitis is a known complication, often emphasized preoperatively.
- Postoperative enterocolitis following reconstruction is less commonly highlighted.
Observation:
- Five pediatric cases experienced unanticipated death from enterocolitis 3 weeks to 20 months post-reconstruction.
- Initial symptoms of enterocolitis were mild and frequently misinterpreted by physicians.
- Sudden, unexpected death occurred within 2 to 12 days of symptom onset.
Findings:
- Fatal postoperative enterocolitis is an under-recognized risk after Hirschsprung's disease surgery.
- Physician awareness regarding this specific complication appears deficient.
- Mild presenting symptoms can mask a rapidly progressing, fatal condition.
Implications:
- Enhanced parent education regarding postoperative warning signs is crucial.
- Improved communication channels between surgeons and referring physicians are necessary.
- Increased vigilance for postoperative enterocolitis in patients with Hirschsprung's disease is recommended.
Abstract:
Unanticipated death from enterocolitis occurred in five children 3 weeks to 20 months after uncomplicated reconstruction for Hirschsprung's disease. In each case the presenting symptoms of enterocolitis were mild and were misinterpreted by examining physicians. Within 2 to 12 days of onset of symptoms, unexpected death occurred. Although fatal enterocolitis is a well-known complication of Hirschsprung's disease, emphasis is usually placed on preoperative enterocolitis. Fatal postoperative enterocolitis is not a new entity associated with Hirschsprung's disease, but physician awareness of this possibility is obviously deficient. We strongly recommend extensive parent education and better postoperative communication between the surgeon and the referring physician.