Assessment of functional outcome following Duhamel retro-rectal pull-through surgery for Hirschsprung's disease: a follow-up study

Context: Hirschsprung's disease (HD) is one of the commonest problems requiring surgery in children. More than 95% of children present during new-born period, when they are treated with leveling colostomy and are followed with pull-through surgery a few months later, once the child has gained adequate weight to withstand a major surgery. The commonest pull through surgery done is the Duhamel retro-rectal pull-through (DRPT) repair. Settings and Design: This is a retrospective study of children who presented to one unit in our institute, a tertiary care referral hospital for children less than 12 years, with HD and underwent DRPT procedure during the period between July 2017 to June 2020. The children were evaluated after three years of follow-up for fecal incontinence and constipation. The study was conducted in children diagnosed with classical segment recto-sigmoid HD who underwent surgery. The children who were diagnosed with HD other than classical segment, who underwent primary pull through surgery and who underwent other repairs for HD were excluded from the study. Results: Thirty-two children underwent DRPT procedure during the study period. Of them, five (15.6%) children were lost on follow-up and one (3.1%) child had expired in the immediate post-operative period. Twenty-six children were included in the study. The bowel function score was calculated. The mean age of definitive surgery was 4.2 years. The follow-up period was a minimum of three years. Only two children had a "good" score of eighteen and above. Nineteen children had a "fair" score of 13-17. Five children had a "poor" score of less than thirteen, and among them, two had a "very poor" score of less than nine. The mean BFS was 13.72. Conclusions: Functional outcomes following Duhamel procedure are satisfactory, with 7.7% of children are in the fringe of requiring another surgery for constipation and pseudo-incontinence. (AU)

Impactación fecal / Fecal impactation

Introducción: La Impactación fecal (I.F.) es la acumulación de materia fecal dura fundamentalmente en el recto, que no puede evacuarse voluntariamente. Es más común en el anciano y en personas debilitadas, inactivas, o que usan drogas por enfermedades psiquiátricas. Objetivo: Evaluar una serie consecutiva de pacientes con I.F., discutir su etiopatogenia y los resultados del tratamiento. Pacientes y método: Entre Enero 2006 y Diciembre 2008, de 26862 internaciones en el Sanatorio Trinidad Dupuytren de la Ciudad de Buenos Aires, 87 (0.32%) fueron por I.F. Mujeres 54 (62%), edad promedio 75 (rango 95-32) años. La I.F. fue baja (en el recto ó el rectosigma) en 50 (57.47%) pacientes y alta en 37 (42.53%). El diagnóstico se hizo con: examen semiológico y proctológico con instrumental rígido, Videocolonoscopía (VCC), radiología directa del abdomen, radiología contrastada del colon y tomografía abdominal computada (TC) según el caso. Resultados: Todos tenían factores condicionantes, más frecuentemente senectud (42.52%), trastornos neurológicos (20.69%), dolicocolon (9.19%) y megacolon chagásico (5.74%). Más del 90% se diagnosticaron con tacto rectal y endoscopía rígida. Las altas con VCC y ocasionalmente TC. Todos recibieron tratamiento médico (enemas tipo Murphy, laxantes y dieta), excepto 3 (3.45%) que fueron operados de emergencia por úlceras estercoráceas con peritonitis localizadas (operaciones tipo Hartmann). En 7 (8.3%) pacientes el tratamiento con enemas fue inefectivo, requiriendo extracción manual con anestesia: 4 y cirugía electiva: 3 (2 colostomías transversas y una cecostomía). Hubieron 9 (10.2%) complicaciones en los pacientes no operados (2 neumopatías, 5 fl ebitis y 2 infecciones urinarias) y 2 en los operados (absceso de pared y eventración). Estadía hospitalaria promedio: 11 (rango 5-45) días. Conclusión: El tratamiento con enemas por goteo, dieta y laxantes es de alta respuesta en la mayoría...

Introduction: Fecal impaction (F.I.) is the accumulation of hard feces, mainly in the rectum, that cannot be voluntarily expelled. It is more common in the elderly and in debilitated, or inactive persons, and those who use drugs for mental diseases. Objective: To assess a consecutive series of patients with con F.I., and discuss the etiopathology, and results of treatment. Patients and Methods: Between January 2006 and December 2008, from 26862 admissions in the Sanatorio Trinidad Dupuytren of Buenos Aires, 87 (0.32%) were for (F.I.) Women 54 (62%), mean age 75 (range 95-32) years. F.I. was low (in rectum or rectosigmoid) in 50 (57.47%) patients, and high in 37 (42.53%). Diagnosis was done with: physical exam, rigid sigmoidoscopy, videocolonoscopy (VC), plain abdominal X-ray, contrast colon radiology, and abdominal computed tomography (CT), case dependent. Results: All patients had conditioning factors, more frequently old age (42.52%), neurological conditions (20.69%), dolicocolon (9.19%) and Chagasic megacolon (5.74%). More than 90% were diagnosed with rectal digital exam and rigid sigmoidoscopy. For those with high impaction VC and occasionally CT were used. All patients had medical treatment (Murphy enemas, laxatives, and diet), except for 3 (3.45%) who underwent emergency surgery for estercoracic ulcers with localized peritonitis (Hartmann type operations). Enemas were ineffective in 7 (8.3%) patients, requiring manual extraction under anesthesia: 4, and elective surgery: 3 (2 transverse colostomies and 1 cecostomy). There were 9 (10.2%) complications in non-operated patients (2 pneumonias, 5 phlebitis, and 2 urinary infections), and 2 in operated patients (abdominal wall abscess, and incisional hernia). Length of stay: 11 (range 5-45) days. Conclusion: Treatment with enemas, diet and laxatives is highly effective in most patients...

Effects of Changrui Enemas on expression of IL-1β and NF-κB in radiation-induced proctitis rats / 肿瘤研究与临床

Objective To observe the effects of Changrui Enemas on IL-1β and NF-κB in the rat model of radiation-induced proctitis, and to explore the mechanism of its repairing mucous membrane and diminishing inflammation. Methods Radiation was given on the pelvis of rats through linear accelerator to establish the model of proctitis. 70 rats were divided into seven groups randomly. Small dose (0.4 g/ml), middle dose(0.8 g/ml) and large dose(1.6 g/ml) of Changrui Enemas by retention enema were given for 7 days, with the admixture liquids of Gentamyein and Dexamethasone, Xilei Powder was used as controls. Changes of IL-1β and NF-κB expression were investigated by semi-quantitative RT-PCR and IHC respectively. Results The expression of IL-1β and NF-κB were determined in the groups accepted radiation, but there had been a dramatic decline in the treatment groups(P<0.05). The high dose treatment group was superior to the low dose one on the whole. Conclusion Changrui Enemas can down-regulate the expression of inflammatory factor IL-1β and NF-κB on radiation induced proctitis rats, and reduce the inflammatory reaction, protect the rectal mucosa, accelerate healing up of the ulcer and relief the symptoms.

Development of Two Cases of Acute Colitis after Soap Enemas / 대한소화기내시경학회지

Acute diarrhea is caused by many situations such as infections, drugs, autoimmune diseases, immunodeficiency, ischemia and toxins. In addition, enema induced-colitis also causes acute diarrhea. Damage to the colon has been reported after exposure to a number of rectally administered agents, the better known of which are soaps and detergents used as cleansing enemas. Soap enemas cause corrosive colitis due to the saponification reaction as well as toxic materials. We report two cases of acute colitis induced by soap enemas administered in preparation for cesarean sections.

Study on Preparation and Quality Standard of Kuijieyu Enemas / 中国药房

OBJECTIVE: To prepare Kuijieyu enemas and establish its quality standard.METHODS: Most of traditional Chinese medicines in prescription were decocted using water and some were crushed.Then they were concentrated to prepare enemas.Pueraria lobata,Rhizoma Coptidis,Scutellaria baicalensis in Kuijieyu enemas were qualitatively identified by TLC.The content of baicalin in Kuijieyu enemas was determined by HPLC.RESULTS: The TLC spots were clear,well-separated and specific.The linear range of baicalin were 210～1 750 ?g(r=0.999 9) with an average recovery of 99.13% (RSD=1.1%,n=6).CONCLUSION: The preparation process is simple and convenient.The quality control method is simple,reliable,specific and reproducible.

TLC Fingerprints of Chloroform Extract of Compound Herba Taraxaci Enemas:Comparison between Batches / 中国药房

OBJECTIVE: To compare TLC fingerprints between different batches of compound Herba taraxaci enemas (CHTE) ant to lay a foundation for establishing a more stable preparation technics and quality standards for CHTE. METHODS: The chloroform extract of 2 batches of CHTE were chromatographed by TLC and the samples were scanned by TLC scanner at a single wavelength of 280nm,the difference between different batches was compared. RESULTS: The TLC of chloroform extracts was well-separated,there were 6 common peaks and 2 non-common peaks in the TLC of 2 batches of samples, with some of the peaks identified in terms of the medicinal material categories, but there was a significant difference in contents among the common peaks. CONCLUSIONS: It was hard to guarantee the relative conformity in numbers of components and the contents between different batches of preparations,the preparation technics and quality standard of raw materials remain to be further optimized and the quality standard for Chinese herb medicinal preparations in hospital should be improved further.