Urushihara N, Kohno S, Hasegawa S
Department of Surgery, Shizuoka Children's Hospital, Japan.
Surg Today. 1994;24(3):221-4. doi: 10.1007/BF02032891.
From 1977 to 1991, we encountered 67 patients with Hirschsprung's disease and 14 of them developed enterocolitis, with 3 cases being fatal. Enterocolitis occurred preoperatively in 12 infants, as well as after ileostomy in one and after a pull-through procedure in another. Seven infants had severe enterocolitis, including three with pseudomembranous enterocolitis and four with hemorrhagic necrotizing enterocolitis. Enterocolitis in Hirschsprung's disease mainly occurs due to intestinal obstruction and ischemia; however, in some cases, Clostridium difficile overgrowth and its toxin also appears to be related to severe pseudomembranous enterocolitis. In severe enterocolitis, antibiotics and enterostomy often prove to be ineffective, and thus an early resection of the affected bowel appears to be necessary. Moreover, when the aganglionic segment extends to the small bowel, severe enterocolitis tends to occur in the aganglionic intestine even after performing an enterostomy, and a resection of the aganglionic bowel is therefore recommended to allow for adequate lavage of the segment distal to the enterostomy site.
1977年至1991年期间，我们共收治了67例先天性巨结肠症患者，其中14例发生了小肠结肠炎，3例死亡。12例婴儿在术前发生小肠结肠炎，1例在回肠造口术后，另1例在拖出式手术术后发生。7例婴儿发生严重小肠结肠炎，其中3例为伪膜性小肠结肠炎，4例为出血性坏死性小肠结肠炎。先天性巨结肠症中的小肠结肠炎主要由肠梗阻和局部缺血引起；然而，在某些情况下，艰难梭菌过度生长及其毒素似乎也与严重的伪膜性小肠结肠炎有关。在严重小肠结肠炎中，抗生素和肠造口术往往无效，因此早期切除受累肠段似乎是必要的。此外，当无神经节段延伸至小肠时，即使进行了肠造口术，无神经节肠段仍易发生严重小肠结肠炎，因此建议切除无神经节肠段，以便对肠造口部位远端的肠段进行充分冲洗。
