ABSTRACT
Context: Hirschsprung's disease (HD) is one of the commonest problems requiring surgery in children. More than 95% of children present during new-born period, when they are treated with leveling colostomy and are followed with pull-through surgery a few months later, once the child has gained adequate weight to withstand a major surgery. The commonest pull through surgery done is the Duhamel retro-rectal pull-through (DRPT) repair. Settings and Design: This is a retrospective study of children who presented to one unit in our institute, a tertiary care referral hospital for children less than 12 years, with HD and underwent DRPT procedure during the period between July 2017 to June 2020. The children were evaluated after three years of follow-up for fecal incontinence and constipation. The study was conducted in children diagnosed with classical segment recto-sigmoid HD who underwent surgery. The children who were diagnosed with HD other than classical segment, who underwent primary pull through surgery and who underwent other repairs for HD were excluded from the study. Results: Thirty-two children underwent DRPT procedure during the study period. Of them, five (15.6%) children were lost on follow-up and one (3.1%) child had expired in the immediate post-operative period. Twenty-six children were included in the study. The bowel function score was calculated. The mean age of definitive surgery was 4.2 years. The follow-up period was a minimum of three years. Only two children had a "good" score of eighteen and above. Nineteen children had a "fair" score of 13-17. Five children had a "poor" score of less than thirteen, and among them, two had a "very poor" score of less than nine. The mean BFS was 13.72. Conclusions: Functional outcomes following Duhamel procedure are satisfactory, with 7.7% of children are in the fringe of requiring another surgery for constipation and pseudo-incontinence. (AU)
Subject(s)
Humans , Male , Female , Treatment Outcome , Colon/surgery , Hirschsprung Disease/therapy , Quality of Life , Health Profile , Retrospective Studies , DefecationABSTRACT
Abstract Chronic constipation in children and adolescents is relatively common and a reason for consultation with pediatricians and proctologists. Most cases respond to medical treatment. Advanced cases of megacolon and megarectum can be treated surgically by Duhamel technique. This case report describes a 15-year-old patient with chronic intestinal constipation refractory to clinical treatment associated with megacolon and megarectum, which was surgically treated.
Resumo A constipação intestinal crônica em crianças e adolescentes é relativamente comum e motivo de consultas a pediatras e coloproctologistas. A maioria dos casos responde ao tratamento clínico. Casos avançados de megacolon e megarreto podem ser tratados cirurgicamente através da cirurgia de Duhamel. Este relato de caso descreve um paciente de 15 anos de idade com quadro de constipação intestinal crônica refratária ao tratamento clínico associada a megacolon e megarreto, o qual foi tratado cirurgicamente.
Subject(s)
Humans , Male , Adolescent , Constipation/complications , Megacolon/surgery , Adolescent , Laparoscopy/methods , Colorectal SurgeryABSTRACT
In spite of the large experience acquired in the last 50 years with the surgical treatment of the Chagasic megacolon, the use of colorectal video laparoscopic surgery brought some controversy in several aspects of the treatment that already had been considered as resolved. One of the basic aspects to the establishment of the colorectal video laparoscopic surgery is to maintain the same procedure of the conventional surgery, since the results obtained in this operation were considered as curative. Constipation is only a symptom of a multisymptomatic disease, and the surgical treatment of acquired megacolon must be considered as definitive in the cure of this symptom; recurrence of the constipation or dilatation after a short period of time must be considered deleterious to the patient. Based in 41 years of experience with the Duhamel procedure in the treatment of 912 patients with acquired megacolon, the authors propose to apply the same technique in the surgical laparoscopic approach of acquired megacolon, including the same colon-recto-anal anastomosis. The results obtained in 56 patients operated on by laparoscopic approach showed the same curative results, but with lower morbidity. (AU)
Apesar da vasta experiência adquirida nos últimos 50 anos com o tratamento cirúrgico do megacolo adquirido, a introdução da cirurgia laparoscópica voltou a trazer controvérsia para alguns pontos anteriormente considerados como esclarecidos. Uma das regras básicas para a introdução da videolaparoscopia no tratamento das enfermidades colorretais tem sido a de se manter a técnica original utilizada em cirurgias pela via convencional, desde que os resultados observados na mesma conduzam à cura dos sintomas ou da enfermidade causal. Em especial, no referente ao tratamento cirúrgico do megacolo adquirido a proposta de um tratamento cirúrgico deve ter em mente que diferentemente do que ocorre com a cirurgia para tratamento de outras enfermidades, benignas ou malignas, neste caso não se almeja o tratamento causal da enfermidade, mas essencialmente a cura da manifestação de um de seus sintomas. É, pois, realmente importante que se considere um tratamento que não venha a resultar em bons resultados por apenas um curto espaço de tempo, mas que possibilite ao paciente livrar-se definitivamente de um sintoma, visto que é possível que em curto espaço de tempo ele venha a necessitar tratar outra manifestação sintomatológica (cardíaca ou esofágica) da enfermidade causal. Baseados na experiência adquirida nos últimos 50 anos (912 pacientes) com a técnica de Duhamel, em que o ponto importante é a realização de uma ampla anastomose da parede anterior do cólon abaixado à parede posterior (mucosa) do reto, ao mesmo tempo em que se anastomosa a parede posterior do cólon abaixado ao canal anal, são analisados os resultados obtidos com esta mesma técnica realizada por laparoscopia. Esta mesma incisão no canal anal serve para a retirada do segmento cólico ressecado, sem necessidade de laparotomia auxiliar. Os resultados observados em 56 pacientes quanto à cura da obstipação são similares aos registrados na cirurgia convencional, porém com um menor índice de morbidade, seja intra ou pós-operatória. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Anal Canal/surgery , Anastomosis, Surgical , Laparoscopy , Megacolon/surgery , Preoperative Care , ConstipationABSTRACT
Objetivo: describir un caso de megacolon Chagásico, como una patología poco frecuente en nuestro medio y la resolución quirúrgica adecuada de sus complicaciones. Sede: hospital de tercer nivel, Dr. Teodoro Maldonado Carbo. Diseño: presentación de caso. Informe del caso: hombre de 73 años con antecedentes de constipación crónica. Acude al servicio de emergencia por constipación, dolor, distensión abdominal, alza térmica y nauseas de 10 días de evolución. Presentaba abdomen distendido, doloroso a la palpación superficial y profunda; se palpa masa, dura, móvil, en flanco derecho; ruidos hidroaéreos disminuidos en intensidad y frecuencia. Ingresa con diagnóstico de obstrucción intestinal. En el trasnquirúrgico se encuentra colon dilatado en su totalidad y masa de contenido fecal a nivel del colon descendente. Se detecta la presencia de anticuerpos anti Tripanosoma Cruzi. Posteriormente se programa operación de Duhamel-Haddad modificada.
Objective: To describe a case of chagasic megacolon, as a little frequent pathology in our environment and the accurate surgical approach for its complications. Seat: Third level Hospital, Dr. Teodoro Maldonado Carbo. Design: case report. Report of the case: 73 year-old male patient with past medical history of chronic constipation. He went to ER with complaints of constipation, abdominal pain and distension, fever and nauseas with an evolution of 10 days. On the physical exam he presented abdominal tenderness on superficial and deep palpation; a hard and mobile mass was felt on the right flank; bowel sounds are diminished in intensity and frequency. He was admitted with a diagnosis of intestinal obstruction. During the surgery we found a thoroughly dilated colon and a mass of fecal content at level of descending colon. Positive titers of anti Trypanosoma Cruzii antibodies were detected. Subsequently the patient underwent a new surgery using a modified Duhamel-Haddad technique.