Abstract
Aim: Postoperative lower gastrointestinal bleeding in children with Hirschsprung's Disease (HSCR) is a non-specific symptom, which may be caused by various etiologies. Our current study aims to utilize colonoscopy to diagnose the causes of postoperative hematochezia and to analyze its feasibility, accuracy, and safety.Methods: Twenty-four patients with HSCR with postoperative lower gastrointestinal bleeding or occult blood in the stool were enrolled in this study. The postoperative onset duration, age at examination, accompanied anomalies were recorded. After bowel preparation, all patients underwent colonoscopy. According to visual findings, mucosal biopsy was performed, followed by pathological diagnosis. Further treatment was determined according to the visual findings and pathological diagnosis. All patients were followed up for 6 months including therapeutic outcomes and recurrence of symptoms.Results: The mean onset duration was (221.3 ± 216.8) days postoperatively (ranging from 25 to 768 days). The mean age at examination was (41.0 ± 29.4) months. There was no significant difference in the onset days among each group (all, p > 0.05). Based on visual and pathological findings, there were 11 cases of HSCR associated enterocolitis (HAEC), 4 cases of anastomotic leakage, 7 cases of anastomotic inflammation, 1 case of juvenile polyp, and 1 case of inflammatory pseudopolyp. Intraluminal saline irrigation, thrombin treatment or colorectal polyp electrocision was performed according to intraoperative diagnosis. Patients with HEAC and anastomotic inflammation underwent antibiotics therapy and colorectal irrigation. Patients with leakage underwent reoperation. The highest incidence of accompanied symptoms of diarrhea existed in HEAC group (p = 0.02) and fever in leakage group (p = 0.02), respectively. No perforation or aggravated bleeding occurs in any patients. All patients gained uneventful recovery during follow-up period.Conclusions: Colonoscopy is a safe, accurate and timely examination for HSCR patients with postoperative lower gastrointestinal bleeding. The visual findings and biopsy may provide accurate diagnosis and guide treatment for this subset of patients.
Highlights
The symptom of rectal bleeding was usually considered to be non-specific [1], when patients with Hirschsprung’s disease (HSCR) experienced hematochezia or occult stool postoperatively, great attention should be paid to the postoperative HSCR associated enterocolitis (HAEC) [1], anastomotic lesions [2], leakage [3] or other complications
Some sporadic reports showed the application of colonoscopy in diagnosing HAEC or other minor lower gastrointestinal bleeding, till there is no report on colonoscopic diagnosis for the group of HSCR patients experiencing postoperative gastrointestinal hematochezia presents or occult blood, nor there is any consensus of the technique and appropriate case target selection
Colonoscopy was performed in the digestive endoscopy room under intravenous anesthesia
Summary
The symptom of rectal bleeding was usually considered to be non-specific [1], when patients with Hirschsprung’s disease (HSCR) experienced hematochezia or occult stool postoperatively, great attention should be paid to the postoperative HSCR associated enterocolitis (HAEC) [1], anastomotic lesions [2], leakage [3] or other complications. For most of patients with hematochezia or positive occult blood, colonoscopy was reported to be a safe, crucial, and accurate examination [4] It help doctors make macroscopical diagnosis through direct vision and histological diagnosis by mucosal biopsy, it helps pediatric surgeons carry out corresponding treatments [5]. Some sporadic reports showed the application of colonoscopy in diagnosing HAEC or other minor lower gastrointestinal bleeding, till there is no report on colonoscopic diagnosis for the group of HSCR patients experiencing postoperative gastrointestinal hematochezia presents or occult blood, nor there is any consensus of the technique and appropriate case target selection. The importance and safety of colonoscopy in this subset of patients were evaluated, analyzed and discussed
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