Enterocolitis In Hirschsprung's Disease
Transcript of Enterocolitis In Hirschsprung's Disease
68 :±,o}£13!\- : All 8 l'! Al1 1 ~ 2002';1 Vo l. 8. No . 1. J une 2002
Enterocolitis In Hirschsprung's Disease
Enterocolitis In Hirschsprung's Disease
Jung Hong M.D.
Department of Surgery, Ajoo University Medical College
Suwon, Korea
Enterocolitis associated with Hirschsprung's disease has been a major cause of morbidity and even mortality. and before and after definitieve surgical treatment . It shows typical clinical characteristics, however . its pathogenesis has been poorly understood. Treatment is diverse, and consists of conservative tertment with intravenous hydration . antibiotics and rectal wash out . and surgical t ertment with t emporatory enterostomy. and other surgical procedures. (J Kor Assoc Pediatr Surg 8(1):68-70). 2002.
Index Words : Hirschsprung's disease, Enterocolitis
Hirschsprung's disease (HD)~ ).~el , *1.!~ 7]l.! oJ] rJl tB
"'i~ ~-2-7J}A] 'Bl.g- ~1.! 0] ~Jj:t.Q.t..} HD~ -tl-~-B
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'i'~<k~l~~!ii'tt,; ff t~ ' > ft';i"" .~, ,i:o;.:\\~,,;;,;i. '0 :CQrreSpondence : Jeong Hong,,;Pediatric' Surgery, 'Ajou~Univerity
;'SJluJol of Medidlie, Pal . IiaI~Ku. Won Ckon-do~g 5/ Suwon, . Kyung,Kee.qp 442;7.49, korel ' . . . " . -.4:- •
INCIDENCE
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CLINICAL FEATURES
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%11 : Enterocolitis In Hirschsprung's Disease 69
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Table 1. Clinical Grading System
I Mild explosive diarrhea; mild or moderate abdominal distension; no systemic manifestations
II Korea Moderate explosive diarrhea; moderate to severe abdominal distension; mild systemic symptoms
III Severe explosive diarrhea; marked abdominal distension; shock or impending shock
POST -PULL-THROUGH ENTEROCOLITIS
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section of Americal Academy of PeciiatricsQ.] :s::"'}oJ] uj-.s
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t:.j.14
RADIOLOGIC STUDY
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PATHOLOGY
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L-prH"'l T~'tIt:.j· (K 2) ,
Table 2, Pathological Grading of Hirschsprung's-associated Enterocolitis
o Normal mucosa
crypt dilatation; mucin retnetion
II cryptitis or < crypt abscesses per HPF
III multiple crypt abscesses per HPF
IV fibrinopurulent debris and mucosal ulceration
V transmural necrosis or perforation
ETIOLOGIES
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stasis) oj] Q.]~ AJ{l-tl1 1i1 ~7] ~Q.] ~TI--&J, AJ{l-tl1 J~mQ.] J!}
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~~ (mucin) -TA~ A~~Q.] 0VJ, 111:I.f 11~ (mucus)Q.] loIJOi
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neuronal dysplasia)%o]q20,
TREATMENT
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.!i!.~~ ~]li'£ §.~s:1A1 '?i'-i::- ~.q- -'1'-{l~1i ~~1f-oJ1 1J-if~% ;..1 i;~ii]·71s:. ~q,
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70
oj] BJ?;j.9.-S- 3j -"JA1]3l (rectal irrigation) 0] A] <';~ 51 7].5:. ~c}.
:C7,]?;j T-~+ ~~?;j~.£ ~,\~t}-i::- 73+-i::- {FJ£o8~, -% ~ ,\~7,:l% A] <,;~~+7 +"i5Jtr-:C*~7H~ (posterior anal my-
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:c ~ 7H ~ (internal sphincterotomy) 0 ] A] t~ .£]7].5:. t } Y. J
~~-c ~Ailt}A] ~-J-q23,24
MORBIDITY AND MORTALITY
0] ~~~ ~,\~.g. ~~7].n% ~ -"JA] 7'1 ~ li73 11 ] ~ ~7}
% 7}Ajyu-fll HDQ} {1:i(!:<§. ;,,}uJ~ 9-Jl~'?l.9.-s-;..i 0-33%
~ %~~~ ~;\~% .!2.0]E-s- "i5J-AJ J ~;\~~ ~~oJ] r)1""'H ;..i
9-~% 7]%0i0F ~q18.
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