Ten-year experience with the swenson procedure in Nigerian children with hirschsprung's disease

Background: Hirschsprung's disease (HD) is a common cause of intestinal obstruction in children. Definitive treatments consist of excision of the aganglionic segment and anastomosing the normal colon to the anal remnant. The outcome of this approach in Nigerian children is not known. The aim of this study was to analyze the short to mid-term outcome of children who have undergone the Swenson Procedure (SPT) as a treatment of HD over a period of 10 years. Patients and Methods: The clinical data of biopsy-proven cases of HD managed at the Obafemi Awolowo University Teaching Hospital; Ile-Ife; Nigeria; between 1998 and 2007 were reviewed. Results: There were 33 children 28 were males and five were females (M 5.6: F = 1). The median age at presentation was eight months (range three days to 11 years). Eighteen (54.5) patients had primary pull-through without colostomy while 15 (45.5) patients had a two-staged operation. The operation was carried out at a median age of 14 months with a range of seven weeks to 11 years; four months. Twenty-one (64) of the patients were older than one year at the time of surgery. The level of aganglionosis was in the recto-sigmoid area in 30 (91) patients. The commonest post-SPT complication was intestinal obstruction from adhesions. Bowel opening varied from once daily to eight times daily; median thrice daily. Conclusion: The Swenson's Procedure is an effective procedure in the treatment of HD in children in Ile Ife; Nigeria

Primary swenson's pull-through in children with chronic constipation: a preliminary report

Background: The discrepancy in diameters of the resected ends coupled with the heavy faecal loads in the colon of chronically constipated children with Hirschsprung's disease makes definitive primary pull-through procedure quite difficulty in this group. Patients and Methods: Four consecutive patients (aged 5 months to 11 years) who presented with chronic constipation were given warm saline enema along with Castor oil per oram twice daily for 1 week before and 2 weeks after full-thickness biopsies that confirmed Hirschsprung's disease. All patients had intravenous Cefuroxime or Ceftriaxone plus Metronidazole at induction of anaesthesia. Intra-operatively; the levels of resections were 6-8 cm proximal to the most contractile part of the colon adjacent to the transition zone observed after complete division of mesenteric vessels. Results: There were three males and one female; aged 5 months to 11 years. The levels of aganglionosis were in the rectosigmoid region; except one in the descending colon. There was one case each of anastomotic stenoses; mild enterocolitis and deep peri-anal excoriation. The bowel motions were two to four times daily within 1 month post-operatively. Conclusion: It can be concluded from this preliminary study that with pre-operative saline enema and oral Castor oil for about 3 weeks in chronically constipated children with Hirschsprung's disease primary pull-through procedures can be performed successfully. However; further prospective work is required with this method

Meconium peritonitis in nigerian children

Background: Meconium peritonitis is a rare disease with a fatal outcome. In Nigeria and Africa; there are only the occasional case reports on the subject matter. Methods: This is a 10-year retrospective study of all patients with meconium peritonitis treated at the University of Maiduguri Teaching Hospital; Maiduguri; Borno State; the Lagos University Teaching Hospital; Lagos State; Obafemi Awolowo University Teaching Hospitals complex; Ile-Ife; Osun State and the Federal Medical Centre Gombe; Gombe State; Nigeria. Results: There were 10 neonates comprising 6 girls and 4 boys. The median age at presentation was 4 days (range 2-6 days). Six of the mothers of the children with meconium peritonitis had a supervised antenatal care and 4 had antenatal ultrasonography but meconium peritonitis was missed. The most common clinical presentation was abdominal distension at birth in 9 of 10 patients. The abdominal X- rays showed calcification and homogenous opacity in 4 patients and pneumoperitoneum in 2 patients. At laparotomy; all the patients had inflammatory adhesion bands and matted bowel loops. The generalized type was the commonest form observed (7 patients) and giant pseudocyst was noted in 2 patients. The commonest sites of perforation were the ileum in 4 patients and jejunum in 3 patients. In one patient the perforation had sealed at laparotomy. Intestinal obstruction was the commonest cause of meconium peritonitis in 7 of 10 patients. In the remaining 3 patients the cause is unknown. The commonest procedure performed was resection and anastomosis (4 patients).The mortality rate was high (50). Conclusion: Our data revealed the rarity of meconium peritonitis and intestinal obstruction as the commonest cause. It is recommended that in patients with an unidentifiable cause a rectal biopsy should be done to rule out Hirschsprung's disease. Early diagnosis; proper operative procedure and meticulous post-operative care should improve their survival

Acute intussusception following a pull-through operation for hirschsprung disease

Acute post-operative intussusception is a rare. This is a report of two cases of acute intestinal intussusception were observed in two children aged 14 months and 2.5 years following operation for Hirschsprung's disease. The first signs appeared at the tenth and the fifth post operative day after a satisfactory post-operative period. These signs were not evocative (pains and more or less stopping of the transit). Acute intussusception should be considered in the differential of post -The signs of premature post-operatory occlusion happen in the two weeks of the intervention in hirsch- sprung disease must help to mention the diagnosis of post-operative intestinal invagination. operative intestinal obstruction occurring within two week of pull-through operation forHirschsprung's disease

A new surgical procedure for treatment of total colonic aganglionosis (TCA)

Under the specific environmental circumstances of a normal developing country, a surgical procedure can save patients born with Total Colonic Aganglionosis. This new one-stage procedure comprises preservation of the ileocaecal valve, partial colon resection and a long ileum patch of the remaining colon and rectum. Normal stool habits were established due to enhanced absorption function of the remaining colon. Normal growth etc. were also noted due to adequate transit time of nutrients in the small intestine. Long-term enterostomy is difficult to manage in any depressed economy and the little ones succumb easily to malabsorption syndrome. So far two patients have benefited from this procedure. One is now 8 years, while the other is 4 years old, 6 years, and over 2 years respectively after definitive surgery