Predictor of Hirschsprung-associated enterocolitis: A regression analysis

Hirschsprung-associated enterocolitis

Abstract

Aim: To identify independent predictors for Hirschsprung-associated enterocolitis (HAEC) through regression analysis of various clinical factors.

Method: This retrospective study examined clinical, surgical, and diagnostic data of patients treated for Hirschsprung's disease (HD), evaluating the impact of various factors like aganglionic segment length and postoperative complications.

Results: We analyzed data from 161 patients with HD. Surgical interventions were split between the Rehbein procedure at 47.2% (n=76) and transanal endorectal pull-through (TEPT) at 52,8% (n=85). The median age at diagnosis was 7 [3-12.5] months. The average length of the aganglionic segment measured 25 [20-30] cm distributed as follows: ultrashort segment (16.9%, n=27), rectosigmoid (47.5%, n=76), descending colon (18.8%, n=30), splenic flexure (12.5%, n=20), transverse colon (3.7%, n=6), and ascending colon (0.6%, n=1). Preoperative enterocolitis was observed in 33.1% (n=53). Postoperative enterocolitis occurred in 28.1% (n=45). Additional interventions included rectal botox injections (2.5%, n=4), myectomies (3.1%, n=5), and re-do surgeries (3.1%, n=5). Anastomotic strictures were noted in 5.6% (n=9) of the cases. Upon analyzing patients who presented with HAEC in the preoperative period, it was determined that the length of the aganglionic segment (p=0.001, OR: 1.07) and the age at diagnosis (p=0.003, OR: 1.03) were independent risk factors for HAEC. A positive correlation was found between Length of aganglionic segment and number of preoperative HAEC (p=0.002, r=0.405).

Conclusion: In our study, it was observed that long-segment Hirschsprung's disease and a delayed age at diagnosis are risk factors for Hirschsprung-associated enterocolitis.