Hirschsprung-associated enterocolitis: Observational study in a paediatric emergency care unit

Abstract

Abstract Introduction Hirschsprung-associated enterocolitis is a significant cause of morbidity and mortality in infants with Hirschsprung's disease. The fact that the symptoms are so variable and unspecific leads to a slow or incorrect diagnosis. The purpose of this study is to identify clinical factors associated with the diagnosis, as well as to evaluate the subsequent management of children with suspected Hirschsprung-associated enterocolitis in a paediatric emergency department. Material and methods A retrospective descriptive study was conducted on patients with Hirschsprung's disease who were seen in a paediatric emergency department between April 2011 and November 2015 due to clinical symptoms compatible with enterocolitis. An analytical multivariate analysis was also performed on the epidemiological and clinical variables associated to enterocolitis. Results A total of 75 consultation episodes in the Paediatric Emergency Department were studied, of which 52% (39) were finally diagnosed as enterocolitis. Overall, diarrhoea was the most frequent reason for consultation (74.7%). Lethargy, abdominal distension, and pathological findings on the X-ray showed a significant association with the diagnosis of Hirschsprung-associated enterocolitis. Hospital admission rate was 77.3%. Conclusion Hirschsprung-associated enterocolitis should be considered in all children with Hirschsprung's disease that consult the Emergency Department, especially those with gastrointestinal symptoms associated with lethargy, abdominal distension and pathological findings on the X-ray. The therapeutic diagnostic process should be initiated as soon as possible, either by clinical observation, if there are any doubts, or by medical treatment if there is a high clinical suspicion.