Enterocolitis following endorectal pull-through procedure in children with Hirschsprung's disease
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C E Blane1, E Elhalaby, A G Coran
1Department of Radiology, University of Michigan, Ann Arbor 48109.
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Post-operative enterocolitis in Hirschsprung
Area of Science:
- Pediatric Surgery
- Radiology
- Gastroenterology
Background:
- Enterocolitis post-pull-through surgery for Hirschsprung's disease is a severe complication.
- Clinical differentiation from gastroenteritis or other surgical issues is challenging.
Purpose of the Study:
- To identify specific radiographic features of enterocolitis in patients with Hirschsprung's disease post-pull-through surgery.
- To improve diagnostic accuracy for this critical condition.
Main Methods:
- Retrospective review of abdominal radiographs from 43 patients (55 enterocolitis episodes) after pull-through surgery for Hirschsprung's disease.
- Radiographs were analyzed for bowel dilatation, air-fluid levels, intestinal cut-off sign, and pneumatosis.
- Comparison with radiographs of other complications and surveillance studies.
Main Results:
- The combination of an intestinal cut-off sign and at least two air-fluid levels demonstrated high diagnostic value.
- This specific radiographic pattern achieved 68% sensitivity and 83% specificity.
- Overall diagnostic accuracy for this sign was 77%.
Conclusions:
- The presence of an intestinal cut-off sign with multiple air-fluid levels on abdominal radiographs is a strong indicator of enterocolitis post-pull-through surgery in Hirschsprung's disease.
- This radiographic finding aids in distinguishing enterocolitis from other post-operative complications.
- Improved radiographic interpretation can lead to earlier diagnosis and management of enterocolitis.
Abstract:
The enterocolitis following a pull-through in Hirschsprung's disease can be life-threatening and difficult to distinguish clinically from gastroenteritis and post-operative complications. We reviewed retrospectively the abdominal radiographs in our series to identify specific radiographic characteristics of this syndrome in this population. A total of 55 episodes of enterocolitis with an abdominal series at presentation were located in the files of 43 patients following pull-through surgery for Hirschsprung's disease. There were 15 abdominal series with other complications of Hirschsprung's disease and surgery (seven cases of small bowel obstruction, one of fistula, one of abscess, six of severe constipation) and 71 surveillance follow-up studies. Radiographs were evaluated for bowel dilatation, air-fluid levels, intestinal cut-off sign, speculation, and pneumatosis. The intestinal cut-off sign with two or more air-fluid levels had sensitivity of 68% and specificity of 83%, with a positive predictive value of 0.71 and overall accuracy of 77%. Our review of enterocolitis following pull-through in children with Hirschsprung's disease concludes that the constellation of an intestinal cut-off sign and at least two air-fluid levels on the abdominal series strongly suggests the diagnosis.