Risk factors or the development of post-operative enterocolitis in short segment Hirschsprung's disease

Abstract

Aim of the study The objective of this study is to identify risk factors associated with the development of post-operative enterocolitis (HACE) in short segment Hirschsprung’s disease (HSCR-S) Methods A retrospective study was carried out for post-operative patients with HSCR-S from 1997 to 2017. HSCR-S was defined as the most proximal extension of aganglionosis limited to the sigmoid colon. An episode of HACE was defined as the presence of i) vomiting or explosive diarrhea; ii) abdominal distension; iii) fever and iv) leukocytosis. Risk factors for the development of HACE were determined using multivariate logistic regression. Main results The medical records of 96 patients were reviewed. The overall incidence of HACE was 20.8% (n=20) and 65.0% (n=13) of HACE occurred within the first year of operation. After a univariate logistic regression analysis, 3 risk factors for HACE were identified: 1) presence of other major anomalies (OR: 1.43 (1.12-2.32), p = 0.041); 2) pre-operative stoma creation (OR: 2.28 (1.47-3.23), p = 0.035); 3) extension of aganglionosis proximal to the rectum (OR: 1.89 (1.05-3.19), p = 0.049). After multivariate logistic regression analysis, a significant association was demonstrated for pre-operative stoma creation (OR: 1.81 (1.08-3.22), p =0.045) and extension of aganglionosis proximal to the rectum (OR: 1.91 (1.37-2.98), p = 0.038). Conclusions The requirement of pre-operative stoma creation and a more proximal extension of aganglionosis are risk factors for the development of post-operative HACE in HSCR-S. Patients with these risk factors should be closely followed up especially during the first year after the operation.