Management of hirschsprung’s disease in medical city in Baghdad 2005-2008

Abstract EN

Hirschsprung's disease is defined as a lack of propagation of propulsive waves and an abnormal or absent relaxation of the internal anal sphincter due to aganglionosis, hypoganglionosis, or dysganglionosis.

In our study there is (84) cases of Hirschsprung's disease admitted to the children welfare teaching hospital in Baghdad over 3 years from Occtober 2005 to October 2008, physical examination and investigations were done (plain abdominal X-ray, Barium enema and rectal biopsy).

All cases were confirmed by rectal biopsy.

Modified Soave (Boley) technique was done for (60) patients.

The presentation, technique of pull through, and complications following surgery were all analyzed and discussed.

The total number of cases were 84 patients with an age ranging from two days to six years and the mean age was (8 months) ; the commonest age group at presentation were those between (1-12) months(58.33 %) of the cases ; the male : female ratio was (3.6:1).

Sixty eight patients (81 %) have positive history of delayed passing meconium more than 48 hours, and 54 patients (64.28 %) presented with constipation and progressive abdominal distention.

13 patients (15.47 %) presented with classical picture of neonatal intestinal obstruction, and other cases presented with perforation (7.14 %), enterocolitis (9.52 %), and fecal impaction (3.57 %).

Rectal biopsy was the confirmatory method of diagnosis of HD in our study.

Twenty nine patients managed firstly by diversion colostomy, and the second stage Boley's procedures were done without protective proximal stoma.

Twelve patients (41 %) had excellent results and the postoperative period was free of any complication.

Thirty one patients managed firstly by diversion stoma, and the second stage Boley's procedures were with protective proximal stoma with less complication ; 15 patients (48.4 %) were free from complications, but 12 patients (46 %) from 26 patients developed complications after closure of the protective stoma.

From our results we can concluded the Boley's technique is a good procedure in the management of Hirschsprung's disease, which is one of the classical problems in pediatric surgery procedures, It provides good continence (no pelvic dissection).

Enterocolitis is a constant complication in both 2 stages and 3 stages methods.

Three stages technique is a safe way to avoid major complications.

There is no big difference between the two methods in postoperative complications, in addition one can avoid the complication of the colostomy closure by the 2 stages method.