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1.
J Surg Res ; 245: 564-568, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31476645

RESUMO

BACKGROUND: Children with Hirschsprung disease (HD) and Down syndrome (DS) are reported to experience a higher incidence of Hirschsprung-associated enterocolitis (HAEC) than those without DS, although whether their individual episodes are more severe is unknown. METHODS: A single-institution retrospective cohort study was performed on all patients with HD admitted with HAEC between 2009 and 2017. Patients were divided into two groups based on an associated diagnosis of DS, and demographics, clinical characteristics at presentation, and clinical outcomes were compared. RESULTS: Of 86 admissions for HAEC over the study period, 12 (14%) were for patients with DS. Patients admitted with and without DS were similar in terms of age (3.0 versus 2.6 y, P = 0.72), male gender (58% versus 77%, P = 0.17), and proportion with disease proximal to the left colon (9% versus 12%, P = 0.70). Patients admitted with DS were more likely to be tachycardic (75% versus 19%, P ≤ 0.001) and hypotensive (33% versus 7%, P = 0.01) at presentation and presented for treatment after a longer duration of symptoms than those without DS (84 versus 24 h, P = 0.001). Patients admitted with DS were more likely to require intensive care unit admission (58% versus 12%, P = 0.006) and received a longer course of antibiotics (13 d versus 7 d, P = 0.02). The length of stay was similar (6 versus 4 d, P = 0.34). CONCLUSIONS: The results of our study suggest that patients with DS experience more severe episodes of HAEC. Ongoing study is needed to identify preventive strategies to decrease the morbidity of HAEC in children with HD and DS.


Assuntos
Síndrome de Down/complicações , Enterocolite/epidemiologia , Doença de Hirschsprung/complicações , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Enterocolite/diagnóstico , Enterocolite/etiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença
2.
Adv Clin Exp Med ; 28(10): 1429-1436, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31670915

RESUMO

BACKGROUND: Hirschsprung's disease-associated enterocolitis (HE) is a life-threatening septic complication of Hirschsprung's disease (HD), leading to bacterial translocation (BT) and sepsis. Many factors, such as intestinal stasis, HD-related inherited immune disorders and abnormal mucosal secretion have been implicated in its pathogenesis. OBJECTIVES: To investigate the effect of intestinal stasis as an independent factor in the pathogenesis of HE intestinal lesions and its systematic effects. MATERIAL AND METHODS: The rectal ganglion cells of 46 Wistar rats were chemically ablated through local benzalkonium chloride (BAC) injection, in order to create a HD model (megacolon rats) that does not carry the possible genetic burden of HD. The animals were sacrificed either on the 20th or 25th day after ablation and were examined for histopathological changes on the wall of the small intestine, presence of bacterial translocation in body organs, body biometrics, and white blood cell count (WBC) and hemoglobin concentration. The results were compared to control animals. RESULTS: In the megacolon rats, severe damage on the small intestine as well as BT proportional to the extent of the intestinal damage and to the time elapsed after ablation was observed. Significant effects on the WBCs, hemoglobin concentration and biometric parameters were also observed. CONCLUSIONS: In megacolon rats, intestinal stasis can lead by itself to a full-blown HE. The HE lesions that promote BT are present even in regions distant from the aganglionic bowel and are proportional to the time elapsed under the influence of intestinal stasis. Systematic effects such as growth retardation are also produced.


Assuntos
Enterocolite , Doença de Hirschsprung/patologia , Obstrução Intestinal , Megacolo/complicações , Animais , Translocação Bacteriana , Modelos Animais de Doenças , Enterocolite/diagnóstico , Enterocolite/etiologia , Intestinos/microbiologia , Megacolo/patologia , Ratos , Ratos Wistar , Sepse
3.
Pediatr Surg Int ; 35(11): 1245-1253, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31535199

RESUMO

PURPOSE: A single-stage pull-through (SSPT) is the most commonly performed procedure for Hirschsprung disease (HSCR) and has been shown to be better than multi-stage procedures. However, performing a SSPT in the neonatal period or early in infancy is a risk factor for an inaccurate diagnosis, post-operative enterocolitis, and a protracted post-operative recovery. The present study was primarily designed to evaluate the feasibility and efficacy of home rectal irrigation in the neonatal period and early in infancy, followed by a delayed and planned SSPT in a prospective cohort with HSCR. METHODS: Between January 2014 and December 2016, a total of 147 neonates diagnosed with HSCR were enrolled in the study. Six patients were excluded as a result of ganglion cells found in second rectal biopsies after the neonatal period. One hundred twenty-two patients successfully underwent 2-4 months of home rectal irrigation during the neonatal period, followed by a SSPT procedure after the neonatal period (group A, n = 122). Nineteen patients were not candidates for home rectal irrigation, and thus, colostomies were performed during the neonatal period followed by multi-stage procedures after the neonatal period (group B, n = 19). One hundred twenty-two healthy children, age- and gender-matched to group A were enrolled as the healthy control group for assessment of nutrition status (group C, n = 122). The birth weight, gender ratio, aganglionic segment, age, and Hirschsprung-associated enterocolitis (HAEC) score at the time of HSCR diagnosis were measured to evaluate the feasibility of home rectal irrigation in neonates and early in infancy. The nutritional indices, including weight, body length, serum albumin, serum prealbumin, serum retinol-binding protein, and incidence of HAEC after 2-4 successful home rectal irrigation, were used to assess the efficacy of home rectal irrigation. Anastomotic strictures or leakage, perianal excoriation, frequency of defecation, and morbidity of post-operative HAEC were recorded to evaluate the beneficial effects to pull through (PT), which were facilitated by home rectal irrigation. RESULTS: Higher HAEC scores and older age at the time of diagnosis of HSCR were associated with group B, compared to group A (4.34 ± 1.25 vs. 11.0 ± 2.56 [t = 18.20, p < 0.05] and 2.8 ± 1.46 days vs. 12.1 ± 5.3 days [t = 16.10, p < 0.05], respectively). The ratio of rectosigmoid HSCR to non-rectosigmoid HSCR was higher in group A than group B (104/18 vs. 4/15 [χ2 = 34.29, p < 0.05]). There were no differences in birth weight, weight at the time of diagnosis of HSCR, and gender ratio between groups A and B. There were no differences in birth weight, birth length, post-home rectal irrigation age, post-home rectal irrigation weight, post-home rectal irrigation length, and post-home rectal irrigation serum albumin between groups A and C (3.47 ± 0.42 kg vs. 3.48 ± 0.40 kg [t = 0.10, p > 0.05], 50.02 ± 0.49 cm vs. 50.05 ± 0.46 cm [t = 0.61, p > 0.05], 98.59 ± 13.34 days vs. 97.83 ± 13.58 days [t = 0.44, p > 0.05], 6.77 ± 0.66 kg vs. 6.97 ± 0.87 kg [t = 1.95, p > 0.05], 61.55 ± 2.14 cm vs. 61.70 ± 2.07 cm [t = 0.59, p > 0.05], and 41.78 ± 2.42 g/L vs. 41.85 ± 2.37 g/L [t = 0.22, p > 0.05], respectively). The rate of HAEC in the period of home rectal irrigation in group A was low; however, the post-home rectal irrigation serum prealbumin level and retinol-binding protein were significantly lower in group A than group C (0.15 ± 0.04 g/L vs. 0.17 ± 0.05 g/L [t = 3.50, p < 0.05] and 22.51 ± 7.53 g/L vs. 30.57 ± 9.26 g/L [t = 7.46, p < 0.05], respectively). There were no anastomotic strictures or leakage after definitive PT performed in group A. The frequency of defecation ranged from 2-6 times per day, 10 patients had perianal excoriation 3 months after PT, and 11 patients had post-operative HAEC during 6 months of follow-up after PT. CONCLUSION: Home rectal irrigation in neonates and early in infancy, followed by a delayed and planned SSPT is feasible and effective in patients with HSCR, and could be beneficial to definitive PT. However, for patients with an extended aganglionic segment, older age, or high HAEC score at the time of diagnosis of HSCR, rectal irrigation maybe not suitable. TRIAL REGISTRATION: This was a prospective comparative study designed to evaluate the effects of home rectal irrigation for facilitating and enhancing recovery after PT, and was registered at Clinical Trials.gov as NCT02776176.


Assuntos
Doença de Hirschsprung/terapia , Reto , Irrigação Terapêutica , Fatores Etários , Enterocolite/etiologia , Estudos de Viabilidade , Feminino , Doença de Hirschsprung/complicações , Humanos , Lactente , Recém-Nascido , Masculino , Pré-Albumina/análise , Estudos Prospectivos , Proteínas de Ligação ao Retinol/análise
4.
World J Gastroenterol ; 25(25): 3268-3280, 2019 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-31333317

RESUMO

BACKGROUND: A large proportion of patients with Hirschsprung disease experience persistent obstructive symptoms after corrective surgery. Persistent obstructive symptoms may result in faecal stasis that can develop into Hirschsprung-associated enterocolitis, a potential life-threatening condition. Important treatment to improve faecal passage is internal anal sphincter relaxation using botulinum toxin injections. AIM: To give an overview of all empirical evidence on the effectiveness of botulinum toxin injections in patients with Hirschsprung disease. METHODS: A systematic review and meta-analysis was done by searching PubMed, EMBASE and the Cochrane Library, using entry terms related to: (1) Hirschsprung disease; and (2) Botulinum toxin injections. 14 studies representing 278 patients met eligibility criteria. Data that were extracted were proportion of patients with improvement of obstructive symptoms or less enterocolitis after injection, proportion of patients with adverse effects and data on type botulinum toxin, mean dose, average age at first injection and patients with associated syndromes. Random-effects meta-analysis was used to aggregate effects and random-effects meta-regression was used to test for possible confounding factors. RESULTS: Botulinum toxin injections are effective in treating obstructive symptoms in on average 66% of patients [event rate (ER) = 0.66, P = 0.004, I 2 = 49.5, n = 278 patients]. Type of botulinum toxin, average dose, average age at first injections and proportion of patients with associated syndromes were not predictive for this effect. Mean 7 duration of improvement after one botulinum toxin injections was 6.4 mo and patients needed on average 2.6 procedures. There was a significant higher response rate within one month after botulinum toxin injections compared to more than one month after Botulinum toxin injections (ER = 0.79, vs ER = 0.46, Q = 19.37, P < 0.001). Botulinum toxin injections were not effective in treating enterocolitis (ER 0.58, P = 0.65, I 2 = 71.0, n = 52 patients). There were adverse effects in on average 17% of patients (ER = 0.17, P < 0.001, I 2 = 52.1, n = 187 patients), varying from temporary incontinence to mild anal pain. CONCLUSION: Findings from this systematic review and meta-analysis indicate that botulinum toxin injections are effective in treating obstructive symptoms and that adverse effects were present, but mild and temporary.


Assuntos
Canal Anal/efeitos dos fármacos , Toxinas Botulínicas Tipo A/administração & dosagem , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Doença de Hirschsprung/cirurgia , Complicações Pós-Operatórias/terapia , Canal Anal/fisiopatologia , Toxinas Botulínicas Tipo A/efeitos adversos , Constipação Intestinal/etiologia , Constipação Intestinal/fisiopatologia , Constipação Intestinal/terapia , Enterocolite/etiologia , Enterocolite/fisiopatologia , Enterocolite/terapia , Doença de Hirschsprung/complicações , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
5.
Rev Alerg Mex ; 66(2): 257-262, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31200424

RESUMO

BACKGROUND: Food protein-induced enterocolitis syndrome or FPIES is a rare, not-IgE-mediated food allergy. The predominant feature is vomit from one to four hours after consuming the causal food. CLINICAL CASE: An 8-month-old boy, with no family history of allergy, with a personal pathological history of allergy to cow's milk protein. At 7 months of age, he had acute gastroenteritis with mixed shock and, at 8 months of age, he had acute gastroenteritis and moderate dehydration. In both episodes, he had eaten rice before the symptoms started. When infectious etiology and other causes of vomit and dehydration were ruled out, the diagnosis of FPIES, which is secondary to rice protein, was made and confirmed with a patch test. CONCLUSION: FPIES should be considered in the differential diagnosis of recurrent gastroenteritis, especially in severe cases without an identified infectious cause.


Assuntos
Proteínas na Dieta/efeitos adversos , Proteínas na Dieta/imunologia , Enterocolite/etiologia , Hipersensibilidade Alimentar/complicações , Humanos , Lactente , Masculino , Síndrome
6.
Medicina (Kaunas) ; 55(6)2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31141916

RESUMO

Acute food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated allergy and is characterized by repetitive profuse vomiting episodes, often in association with pallor, lethargy, and diarrhea, presenting within 1-4 h from the ingestion of a triggering food. In 2017, the international consensus guidelines for the diagnosis and management of FPIES were published. They cover all aspects of this syndrome, which in recent decades has attracted the attention of pediatric allergists. In particular, the consensus proposed innovative diagnostic criteria. However, the diagnosis of acute FPIES is still currently discussed because the interest in this disease is relatively recent and, above all, there are no validated panels of diagnostic criteria. We propose some ideas for reflection on the diagnostic and suspicion criteria of acute FPIES with exemplary stories of children certainly or probably suffering from acute FPIES. For example, we believe that new definitions should be produced for mild forms of FPIES, multiple forms, and those with IgE-mediated symptoms. Moreover, we propose two clinical criteria to suspect acute FPIES and to refer the child to the diagnostic oral food challenge.


Assuntos
Proteínas na Dieta/efeitos adversos , Enterocolite/etiologia , Animais , Bovinos , Criança , Pré-Escolar , Enterocolite/dietoterapia , Feminino , Hipersensibilidade Alimentar/complicações , Humanos , Lactente , Letargia/etiologia , Masculino , Leite/efeitos adversos
7.
Rev Med Chil ; 147(2): 256-260, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31095177

RESUMO

Adenovirus (ADV) is a recognized cause of severe disease among immunocompromised patients. We report a previously healthy 39-year-old female, admitted with influenza pneumonia and evolving with lung hemorrhage and acute renal failure requiring mechanical ventilation and hemodialysis. She received high corticosteroid doses due to an initial suspicion of alveolar hemorrhage. Lymphopenia already present before steroid use (567/µL), was maintained during the whole hospital stay (mean 782/µL). From the second week of admission she presented a high-volume diarrhea (mean 2.5 L/day) associated to intermittent bloody stools. An ulcerative enterocolitis was confirmed by CT images and colonoscopy. ADV was detected in a colonic tissue sample by real time PCR but not by a commercial filmarray test. Cidofovir-probenecid and racecadotril therapy were indicated without changing the clinical course of diarrhea and the patient finally died.


Assuntos
Infecções por Adenoviridae/complicações , Infecção Hospitalar/etiologia , Enterocolite/etiologia , Hemorragia Gastrointestinal/etiologia , Hospedeiro Imunocomprometido , Adenoviridae/isolamento & purificação , Infecções por Adenoviridae/microbiologia , Adulto , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/imunologia , Diarreia/complicações , Enterocolite/diagnóstico , Enterocolite/imunologia , Evolução Fatal , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/imunologia , Humanos
8.
Dev Period Med ; 23(1): 67-78, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-30954984

RESUMO

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy with varying degrees of severity. The acute form of the disease is manifested by vomiting, lethargy and pallor, which usually appear within 1-4 hours after food ingestion, and can lead to shock. The most common trigger foods are: cow's milk, soy, rice and oats. Chronic FPIES is typical for infants fed with cow's milk or soy infant formula and is manifested by chronic vomiting, diarrhea and failure to thrive. In the vast majority of patients with FPIES, the analysis of the clinical history is sufficient to diagnose and identify trigger foods. If the history is unclear, use an oral food challenge to help confirm the diagnosis. Long-term management of patients with FPIES involves elimination of the trigger foods, monitoring for FPIES resolution and caregivers' education. The majority of children acquire food tolerance at the age of 3-5.


Assuntos
Enterocolite/etiologia , Hipersensibilidade Alimentar/complicações , Gerenciamento Clínico , Enterocolite/diagnóstico , Enterocolite/prevenção & controle , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/prevenção & controle , Humanos , Lactente , Recém-Nascido , Doenças Raras
11.
Ann Allergy Asthma Immunol ; 122(4): 407-411, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30742916

RESUMO

BACKGROUND: Food protein-induced enterocolitis syndrome (FPIES) is an infrequent non-IgE-mediated gastrointestinal allergic disorder that occurs mostly in infants and young children. FPIES food triggers vary among different geographic locations, and the condition is still underdiagnosed and underrecognized. OBJECTIVE: To identify the triggers, characteristics, and management of FPIES in a pediatric US population of 74 children presenting to a tertiary center during a 3-year period. METHODS: We performed a retrospective electronic record review of all pediatric patients with a diagnosis of FPIES who presented to Texas Children's Hospital emergency centers and clinics. RESULTS: Most of our patients were white, and 65% had a positive family history of atopy. The median age at the first FPIES episode was 5 months (interquartile range, 4-6 months), and the median age at diagnosis was 11 months (interquartile range, 7-16 months). Grains (88%), cow's milk (49%), and vegetables (43%) were the most common food triggers in our cohort. Of the fruits, banana (24%) and avocado (16%) were predominantly reported. More than half of our patients experienced FPIES to multiple food triggers. CONCLUSION: In our cohort, rice (53%) was the most common individual food trigger, surpassing cow's milk and soybean, previously reported as the most prevalent FPIES triggers in the United States. Banana (24%) and avocado (16%) rates were also much higher than in other studied populations, likely a reflection of different dietary and weaning habits in our area. Time from disease presentation to diagnosis was delayed, potentially because of difficulties in disease recognition. We noted a significant percentage of multiple-food FPIES in contrast to other populations.


Assuntos
Proteínas na Dieta/efeitos adversos , Enterocolite/etiologia , Hipersensibilidade Alimentar/etiologia , Adolescente , Alérgenos/efeitos adversos , Criança , Pré-Escolar , Enterocolite/epidemiologia , Feminino , Alimentos/efeitos adversos , Hipersensibilidade Alimentar/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Estados Unidos/epidemiologia
13.
J Pediatr Surg ; 54(5): 959-963, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30808539

RESUMO

PURPOSE: This study aims to characterize risk factors for Hirschsprung-associated enterocolitis (HAEC). We hypothesize that earlier pull-through surgery is associated with lower risks of developing postoperative HAEC. METHODS: A comparative study of 171 Hirschsprung patients treated from 1990 to 2017 was performed. Patients without HAEC were compared to patients with preoperative and/or postoperative HAEC. Results are presented as median [IQR] or frequency (%). Pearson's χ2 test and Wilcoxon rank sum test were performed with a significance level at p < 0.05. Multivariable logistic regression analysis was used to adjust for potential confounders. A subanalysis was done to evaluate laparoscopic, laparotomy, and transanal surgeries. RESULTS: Risk of developing preoperative HAEC was significantly associated with congenital malformations (OR 2.63 [1.11, 6.24]; p = 0.02). Birth weight was lower in patients with preoperative HAEC (OR 0.48 [95% CI 0.25, 0.93]; p = 0.03). On regression analysis, intestinal obstruction after surgery was significantly associated with postoperative HAEC (OR 8.2 [3.18, 21.13]; p < 0.0001). Patients with earlier pull-through surgery did not have a lower risk of developing postoperative HAEC. CONCLUSIONS: Timing of surgery does not seem to be associated with a higher risk of developing pre- and postoperative HAEC. Predisposing factors for preoperative HAEC included associated malformations and lower birth weight, whereas intestinal obstruction was found to be associated with postoperative HAEC. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: Level III.


Assuntos
Peso ao Nascer , Anormalidades Congênitas/epidemiologia , Enterocolite/epidemiologia , Doença de Hirschsprung/cirurgia , Obstrução Intestinal/epidemiologia , Enterocolite/etiologia , Feminino , Doença de Hirschsprung/complicações , Humanos , Incidência , Lactente , Recém-Nascido , Laparoscopia , Masculino , Período Pós-Operatório , Período Pré-Operatório , Fatores de Risco , Fatores de Tempo , Cirurgia Endoscópica Transanal
14.
Med J Aust ; 210(2): 94-99, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30656696

RESUMO

Food protein-induced enterocolitis syndrome (FPIES) is a poorly understood non-IgE gastrointestinal-mediated food allergy that predominantly affects infants and young children. Cells of the innate immune system appear to be activated during an FPIES reaction. Acute FPIES typically presents between one and 4 hours after ingestion of the trigger food, with the principal symptom being profuse vomiting, and is often accompanied by pallor and lethargy. Additional features can include hypotension, hypothermia, diarrhoea, neutrophilia and thrombocytosis. In Australia, the most commonly reported foods responsible for FPIES are (in descending order) rice, cow's milk, egg, oats and chicken. Most children with FPIES react to only one food trigger, and thus, avoidance of multiple foods is often not indicated. FPIES is often misdiagnosed as sepsis or gastroenteritis. However, a diagnosis of FPIES is favoured if there is rapid resolution of symptoms within hours of presentation, an absence of fever, and a lack of a significant rise in C-reactive protein at presentation. Diagnosis is often hampered by the lack of awareness of FPIES, absence of reliable biomarkers, the non-specific nature of the presenting symptoms, and the delay between allergen exposure and symptoms. Although some national peak allergy bodies have attempted to improve the diagnosis and management of FPIES, up until 2017 there were no internationally agreed guidelines for its diagnosis and management.


Assuntos
Enterocolite , Hipersensibilidade Alimentar , Austrália , Pré-Escolar , Proteínas na Dieta/efeitos adversos , Enterocolite/diagnóstico , Enterocolite/etiologia , Enterocolite/terapia , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/terapia , Humanos , Lactente , Guias de Prática Clínica como Assunto , Síndrome
16.
Pediatr Surg Int ; 35(2): 203-207, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30390138

RESUMO

PURPOSE: Our institution employs rectoplasty with a posterior triangular colonic flap (RPTCF) for classic-type Hirschsprung's disease. Recently, we employed a modified Soave procedure: transanal endorectal pull-through with rectoanal myotomy (TEPTRAM). In both procedures, the internal sphincter muscle is completely divided vertically at the 6 o'clock position. Unlike RPTCF, TEPTRAM does not require abdominal manipulation. We aimed to verify the usefulness of TEPTRAM. METHODS: 64 patients with classic-type Hirschsprung's disease who underwent surgery between 1970 and 2017 were divided into group R (RPTCF, 47 cases) and group T (TEPTRAM, 17 cases). We compared the defecation function of the groups. RESULTS: No patient showed fecal incontinence (R: 0/41, T: 0/10, ns). Three patients (6%) in group R and four (24%) in group T developed postoperative enterocolitis (P = 0.16). Three patients (10%) in group R and one (20%) in group T needed an enema (P = 0.36). CONCLUSION: There was no adverse effect of rectoanal myotomy; incontinence was not observed in either procedure. Although there was no significant difference, the incidences of enterocolitis and constipation were slightly higher in group T, perhaps because of the residual muscle cuff; therefore, it is necessary to provide best care with attention to constipation immediately after surgery.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Doença de Hirschsprung/cirurgia , Miotomia , Criança , Pré-Escolar , Constipação Intestinal/etiologia , Enterocolite/etiologia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos
17.
Pediatr Surg Int ; 35(2): 187-191, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30386902

RESUMO

AIM OF THE STUDY: The objective of this study is to identify risk factors associated with the development of post-operative enterocolitis (HAEC), 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 HAEC was defined as the presence of (1) vomiting or explosive diarrhea; (2) abdominal distension; (3) fever and (4) 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 HAEC was 20.8% (n = 20) and 65.0% (n = 13) of HAEC occurred within the first year of operation. After a univariate logistic regression analysis, three risk factors for HAEC were identified: (1) presence of other major anomalies [OR: 1.43 (1.12-2.32), p = 0.041]; (2) creation of pre-operative defunctioning stoma [OR: 2.28 (1.47-3.23), p = 0.035]; (3) extension of aganglionosis to the sigmoid colon [OR: 1.89 (1.05-3.19), p = 0.049]. After multivariate logistic regression analysis, a significant association was demonstrated for creation of pre-operative defunctioning stoma [OR: 1.81 (1.08-3.22), p = 0.045] and extension of aganglionosis to the sigmoid colon [OR: 1.91 (1.37-2.98), p = 0.038]. CONCLUSIONS: The requirement of pre-operative defunctioning stoma and a more proximal extension of aganglionosis are risk factors for the development of post-operative HAEC in HSCR-S. Patients with these risk factors should be closely followed up especially during the first year after the operation.


Assuntos
Enterocolite/etiologia , Doença de Hirschsprung/cirurgia , Complicações Pós-Operatórias , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de Risco , Estomas Cirúrgicos/efeitos adversos
18.
Pediatr Emerg Care ; 35(7): e131-e132, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28328696

RESUMO

Hirschsprung disease is a congenital abnormality that can be surgically corrected. However, Hirschsprung-associated enterocolitis can be a life-threatening sequela. Very little has been published in the emergency medicine literature about the risk of enterocolitis and shock in patients with a history of Hirschsprung disease. We describe the case of a 6-month-old male infant with a history of multiple surgeries for Hirschsprung disease who presented to the emergency department with a seemingly benign viral gastrointestinal illness. His stable condition led him to be discharged. However, 4 days later, he returned to the emergency department with severe diarrhea and was subsequently admitted to the pediatric intensive care unit for the management of enterocolitis and shock. With this case report, we aim to raise emergency physicians' awareness of the serious and possibly fatal complications of Hirschsprung disease. We argue that this single element of a patient's medical history can alter the management of seemingly simple viral gastrointestinal illnesses; rather than be discharged, such a patient requires surgical consultation and possibly admission for close monitoring and treatment.


Assuntos
Enterocolite/etiologia , Doença de Hirschsprung/complicações , Enterocolite/terapia , Doença de Hirschsprung/cirurgia , Humanos , Lactente , Masculino , Choque/etiologia
19.
Zhonghua Wei Chang Wai Ke Za Zhi ; 21(12): 1387-1390, 2018 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-30588590

RESUMO

OBJECTIVE: To investigate the risk factors of methicillin-resistant Staphylococcus aureus(MRSA) enterocolitis after gastrointestinal surgery. METHODS: Clinical and pathological data of 17 cases with MRSA enteritis after gastrointestinal surgery from March 2015 to March 2017 at Department of General Surgery of Affiliated Drum Tower Hospital were retrospectively analyzed. INCLUSION CRITERIA: (1) age of 18 to 80 years;(2) with history of gastrointestinal surgery; (3) diarrhea symptoms within 7 days after gastrointestinal surgery; (4) use of antibiotics before diarrhea; (5) fecal smear showing a large number of gram positive cocci; (6) fecal culture suggested the presence of MRSA; (7) application of antibiotic therapy against MRSA was effective. EXCLUSION CRITERIA: (1)clostridium difficile toxin positive; (2) toxic shock syndrome caused by food poisoning. According to gender, age, and inpatient ward, 1:2 pairing was performed, and 34 patients with non-MRSA enteritis from the hospitalized cases in the same ward were selected as the control group for retrospective case-control study. There were no significant differences in the gender, age, and constitution index between two groups (all P>0.05), indicating that the two groups were comparable. The χ² test was used to perform univariate analysis on 11 factors, including the nature of the primary disease, colorectal surgery, emergency surgery, use of multiple antibiotics, preoperative bowel preparation, perioperative hormone, intraoperative intraperitoneal chemotherapy, perioperative nasogastric tube, diabetes history, intensive care unit stay, and previous infectious disease hospitalization, and then multivariate logistic regression analysis was performed. RESULTS: MRSA enteritis occurred 3 to 5 days after surgery in all the 17 cases, and 4 cases developed septic shock rapidly. Univariate analysis showed that the operation site (colorectal surgery) (χ²=4.747, P=0.029) and use of two antibiotics before MRSA enteritis (χ²=3.959, P=0.047) were associated with MRSA enteritis after gastrointestinal surgery. Multivariate logistic regression analysis revealed that colorectal surgery was the only independent risk factor for MRSA enteritis after gastrointestinal surgery(OR=5.526, 95%CI: 1.350-22.602,P=0.017), while the use of two antibiotics was not (OR=0.204, 95%CI:0.051-0.819, P=0.025). CONCLUSIONS: MRSA enteritis has a rapid onset, and a high incidence of septic shock, which requires immediate attention. Colorectal surgery is an independent risk factor for MRSA enteritis.


Assuntos
Cirurgia Colorretal , Enterocolite , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Antibacterianos , Estudos de Casos e Controles , Cirurgia Colorretal/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Enterocolite/etiologia , Enterocolite/microbiologia , Humanos , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/etiologia
20.
Front Immunol ; 9: 2318, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30356663

RESUMO

Escherichia coli is a facultative anaerobic symbiont found widely among mammalian gastrointestinal tracts. Several human studies have reported increased commensal E. coli abundance in the intestine during inflammation; however, host immunological responses toward commensal E. coli during inflammation are not well-defined. Here, we show that colonization of gnotobiotic mice with different genotypes of commensal E. coli isolated from healthy conventional microbiota mice and representing distinct populations of E. coli elicited strain-specific disease phenotypes and immunopathological changes following treatment with the inflammatory stimulus, dextran sulfate sodium (DSS). Production of the inflammatory cytokines GM-CSF, IL-6, and IFN-γ was a hallmark of the severe inflammation induced by E. coli strains of Sequence Type 129 (ST129) and ST375 following DSS administration. In contrast, colonization with E. coli strains ST150 and ST468 caused mild intestinal inflammation and triggered only low levels of pro-inflammatory cytokines, a response indistinguishable from that of E. coli-free control mice treated with DSS. The disease development observed with ST129 and ST375 colonization was not directly associated with their abundance in the GI tract as their levels did not change throughout DSS treatment, and no major differences in bacterial burden in the gut were observed among the strains tested. Data mining and in vivo neutralization identified IL-6 as a key cytokine responsible for the observed differential disease severity. Collectively, our results show that the capacity to exacerbate acute intestinal inflammation is a strain-specific trait that can potentially be overcome by blocking the pro-inflammatory immune responses that mediate intestinal tissue damage.


Assuntos
Suscetibilidade a Doenças , Enterocolite/etiologia , Enterocolite/metabolismo , Escherichia coli , Microbioma Gastrointestinal , Interleucina-6/biossíntese , Animais , Biópsia , Citocinas/biossíntese , Modelos Animais de Doenças , Progressão da Doença , Enterocolite/patologia , Escherichia coli/classificação , Escherichia coli/genética , Feminino , Microbioma Gastrointestinal/imunologia , Imunomodulação , Interleucina-6/metabolismo , Mucosa Intestinal/imunologia , Mucosa Intestinal/metabolismo , Mucosa Intestinal/microbiologia , Mucosa Intestinal/patologia , Masculino , Camundongos , Tipagem de Sequências Multilocus , Filogenia
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