Congenital lower intestinal tract anomalies: review of surgical management of 50 Iraqi patients in Al-Najaf City

Congenital lower intestinal tract anomalies are significant cause of morbidity and mortality in children, classified in two groups, major one is anorectal malformation, other one Hirchsprung's disease, usually associated with other anomalies and should be treated as early as possible. To show the prevalence and our experience with congenital lower intestinal tract anomalies in AL-Najaf city. A total 50 patients had various types of congenital lower intestinal tract anomalies, 22 of them high types [anorectal] treated by 3 stages operations[preliminary colostomy, nearly new definitive surgery infracoccygeal approach and closure colostomy], minor surgery for low types [12] and for Hirchsprung's disease treated by usual pull through operation[Swenson's]. The anorectal anomalies [A.R.M] are the most common anomalies of lower intestinal tract, high type cases were 25, low type were 12 cases and Hirchsprung's disease were13 cases. Male were 30 cases and female were 20 cases, age of presentation between first day of life and 18 years of life. Infracoccygeal approach was the safe and non complicated operation in dealing with high type of anorectal malformation and the good results obtained when the operation was done early period of life [around one year]

[Clinical manifestations of Hirschsprung's disease: a 6-year course review in Rasht]

Hirschsprung's disease [H.D] is a congenital disease in which intestinal ganglionic cells are absent and can cause intestinal obstruction. The disease has various clinical manifestations and different length of bowel may be involved. Our aim was to study Hirschsprung's clinical presentations and its rate of intestinal involvement in hospitalized patients in a 6-year course study in Rasht. The capital city of Gillan province in north of Iran. We studied the Hirschsprung's patients referred to Poursina Referal Hospital between 1995-2001. A cross sectional descriptive- analytic study whose data was collected from patient's files and questionnaires including demographic data, disease presentations, diagnostic methods, involved segment, surgical procedure types, surgical complications. Finally, the data was analyzed in SPSS10 software. We detected 58 H.D in these 6 years, whom underwent surgery. There were 19 females and 39 males. Age of patients differed from one day to 18 year. Clinical findings were variable as follow: constipation [79.31%], abdominal distention [67.24%], inability to pass mecunium [17.24%], diarrhea [5.17%] and other less common manifestations. Pathologically, we divided our patients into 3 kinds: rectosigmoid, ultra short - segment, total - colonic. Surgeries were performed in three ways as follow Swenson - Soave - Lynn. Early complications, which come within one month after operation, contain anastomotic leakage [10.2%], prolonged constipation [10.2%]. There were not any significant differences between these three types of surgical procedures. Majority of patients presented with a chronic course of constipation and abdominal distention. There wasn't any difference between kinds of involvement and age and type of presentations. There are few associated anomalies in our patients. In some cases, surgical complications were less than other studies; so, it is probable that our procedures had fewer complications or they had performed in appropriate time

Abordagem cirúrgica do megacólon congênito: estudo retrospectivo / Surgical approach of congenital megacolon: retrospective study

Estudo retrospectivo realizado entre janeiro de 1986 e junho de 1998 no Hospital Universitário da Universidade Federal de Sergipe com o objetivo de analisar os dados epidemiológicos, quadro clínico, meios diagnósticos, opçöes terapêuticas e índice de morbimortalidade de pacientes portadores da Doença de Hirschsprung que foram submetidos a tratamento cirúrgico. Foram avaliados 29 pacientes com predomínio do sexo masculino(80 por cento) e incidência maior em pacientes abaixo de um ano de idade (72,5 por cento). As manifestaçöes clínicas mais freqüentes foram a distensäo abdominal (48,3 por cento) seguida da obstruçäo intestinal (38 por cento), constipaçäo (34,5 por cento), toque retal com fezes explosivas (31 por cento) e vômitos biliosos (31 por cento). Os exames complementares mais utilizados foram o enema opaco (58,6 por cento), seguido da radiografia simples de abdome (48,3 por cento) e da biópsia de cólon (45 por cento). O procedimento cirúrgico definitivo mais executado foi a cirurgia de Duhamel modificada (44,5 por cento). Em 27,6 por cento dos pacientes houve relato de algum tipo de complicaçäo pós-operatória. A infecçäo de ferida operatória foi a complicaçäo mais freqüente nos pacientes submetidos à cirurgia definitiva (37,5 por cento). O procedimento cirúrgico que apresentou maior índice de morbidade foi a cirurgia de Duhamel Haddad (67 por cento). Ocorreram 2 óbitos, ambos em pacientes com enterocolite que foram colostomizados. A morbidade do procedimento cirúrgico definitivo foi zero. De acordo com os dados encontrados, a cirurgia de Duhamel mostrou-se vantajosa e eficaz no tratamento da Doença de Hirschsprung. O índice de morbidade da cirurgia definitiva foi alto, porém, foram complicaçöes de fácil correçäo e sem mortalidade

Incidencia, Diagnóstico y Tratamiento del Megacolon Congénito en Nariño

Se estudiaron 29 casos clínicos de megacolon congénito en Nariño en un período de 1984 a 1988 en cinco instituciones médicas, encontrándose una incidencia de 1-5.000 nacidos vivos, con una relación de 4:1 con predominio del sexo masculino, sin asociaciones con anomalías congénitas, un compromiso predominante de segmentos ultracorto y corto de 96.5 por ciento; se hizo el diagnóstico con base en la clínica colon por enema y biopsia clásica; para segmento ultracorto se empleó como técnica de elección la rectomiectomía Lynn y para segmento corto y largo la técnica de Soave y de Ikeda; obteniéndose mejores resultados y una marcada disminución de complicaciones con el último método