Total Colonic Hirschsprung's Disease: The Hypermotility and Skin Rash Protocol.
Age Factors
Child
Child, Preschool
Clinical Protocols
Combined Modality Therapy
Diarrhea
/ etiology
Exanthema
/ etiology
Female
Follow-Up Studies
Hirschsprung Disease
/ surgery
Humans
Infant
Male
Perioperative Care
/ methods
Postoperative Complications
/ therapy
Retrospective Studies
Toilet Training
Treatment Outcome
Journal
European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie
ISSN: 1439-359X
Titre abrégé: Eur J Pediatr Surg
Pays: United States
ID NLM: 9105263
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
pubmed:
21
8
2019
medline:
7
4
2021
entrez:
21
8
2019
Statut:
ppublish
Résumé
Total colonic Hirschsprung's disease (TCHD) presents a postoperative challenge due to multiple stools and perineal rash. We propose a protocol developed by pediatric surgeons and ostomy nurses to help prevent and treat hypermotility and severe perineal rash, especially in younger children who are not toilet trained. We retrospectively reviewed our TCHD patients' charts from 2014 to 2017. All patients received a prescribed protocol for the treatment of hypermotility and perineal rash. We describe patients who underwent their pull through before and after the age of urine toilet training, and assessed the number of bowel movements, the perineal skin status, and growth. We treated 25 patients. Out of 25, 9 patients received a straight ileoanal pull through before the age of 18 months. Nine of 25 patients presented for a second opinion and had redo pull through. The remaining seven presented for bowel management after having a pull through at another institution. All these were treated following the hypermotility protocol. In total, 19 of 25 patients were not toilet trained. The mean number of bowel movements in all groups was 4 (3-5). All had a resolution of perineal rash and liquid stools after 3 months. Eleven of the 25 patients presented with failure to thrive. Two older patients experienced severe proctalgia requiring replacement of the ileostomy. TCHD patients who underwent definitive pull through had nine high incidence of multiple stool, perineal rash, and low growth. With the implementation of bowel management care to slow the stools and a perineal skin protocol to treat the skin, we believe that these symptoms can be minimized even in patients who are not toilet trained. Since the implementation of this protocol, we have changed our practice to perform the pull through in such patients between the age of 6 and 18 months.
Identifiants
pubmed: 31430765
doi: 10.1055/s-0039-1694744
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
309-316Informations de copyright
Georg Thieme Verlag KG Stuttgart · New York.
Déclaration de conflit d'intérêts
None declared.