Enterocolitis associated with Hirschsprung's disease: A clinical histopathological correlative study
Enterocolitis associated with Hirschsprung's disease (HEC) remains a major source of morbidity and even mortality, both before and after definitive surgical treatment. This study was undertaken to investigate whether histopathologic mucosal changes, in the absence of clinical manifestations of...
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Published in | Journal of pediatric surgery Vol. 30; no. 7; pp. 1023 - 1027 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
United States
Elsevier Inc
01.07.1995
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Abstract | Enterocolitis associated with Hirschsprung's disease (HEC) remains a major source of morbidity and even mortality, both before and after definitive surgical treatment. This study was undertaken to investigate whether histopathologic mucosal changes, in the absence of clinical manifestations of HEC, could predict the subsequent development of this complication. The clinical data and histopathology of 25 patients who eventually developed clinical HEC were compared with a control group of 25 age- and sex-matched patients with Hirschsprung's disease (HD) but with no clinical HEC either preoperatively or postoperatively. The histopathologic findings of tissue obtained by rectal biopsy or during laparotomy were graded from 0 to V according to severity and compared with the eventual clinical course. This study showed that (1) histopathologic findings of HEC appear to predict the clinical development, but not the severity, of future episodes of clinical HEC; (2) a histological grade of ≥II (≥2 crypt abscesses per high power field) should raise suspicion for subsequent occurrence of HEC, whereas a grade of ≥III (multiple crypt abscesses) places a child at high risk for development of clinical HEC; and (3) contrary to what is generally though, histopathologic changes of HEC occur in both ganglionic and aganglionic segments. Based on these findings, it is recommended that histopathologic documentation of HEC and its grade should be an integral part of the tissue diagnosis of HD. |
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AbstractList | Enterocolitis associated with Hirschsprung's disease (HEC) remains a major source of morbidity and even mortality, both before and after definitive surgical treatment. This study was undertaken to investigate whether histopathologic mucosal changes, in the absence of clinical manifestations of HEC, could predict the subsequent development of this complication. The clinical data and histopathology of 25 patients who eventually developed clinical HEC were compared with a control group of 25 age- and sex-matched patients with Hirschsprung's disease (HD) but with no clinical HEC either preoperatively or postoperatively. The histopathologic findings of tissue obtained by rectal biopsy or during laparotomy were graded from 0 to V according to severity and compared with the eventual clinical course. This study showed that (1) histopathologic findings of HEC appear to predict the clinical development, but not the severity, of future episodes of clinical HEC; (2) a histological grade of > or = II (> or = 2 crypt abscesses per high power field) should raise suspicion for subsequent occurrence of HEC, whereas a grade of > or = III (multiple crypt abscesses) places a child at high risk for development of clinical HEC; and (3) contrary to what is generally thought, histopathologic changes of HEC occur in both ganglionic and aganglionic segments. Based on these findings, it is recommended that histopathologic documentation of HEC and its grade should be an integral part of the tissue diagnosis of HD. Enterocolitis associated with Hirschsprung's disease (HEC) remains a major source of morbidity and even mortality, both before and after definitive surgical treatment. This study was undertaken to investigate whether histopathologic mucosal changes, in the absence of clinical manifestations of HEC, could predict the subsequent development of this complication. The clinical data and histopathology of 25 patients who eventually developed clinical HEC were compared with a control group of 25 age- and sex-matched patients with Hirschsprung's disease (HD) but with no clinical HEC either preoperatively or postoperatively. The histopathologic findings of tissue obtained by rectal biopsy or during laparotomy were graded from 0 to V according to severity and compared with the eventual clinical course. This study showed that (1) histopathologic findings of HEC appear to predict the clinical development, but not the severity, of future episodes of clinical HEC; (2) a histological grade of > or = II (> or = 2 crypt abscesses per high power field) should raise suspicion for subsequent occurrence of HEC, whereas a grade of > or = III (multiple crypt abscesses) places a child at high risk for development of clinical HEC; and (3) contrary to what is generally thought, histopathologic changes of HEC occur in both ganglionic and aganglionic segments. Based on these findings, it is recommended that histopathologic documentation of HEC and its grade should be an integral part of the tissue diagnosis of HD. Enterocolitis associated with Hirschsprung's disease (HEC) remains a major source of morbidity and even mortality, both before and after definitive surgical treatment. This study was undertaken to investigate whether histopathologic mucosal changes, in the absence of clinical manifestations of HEC, could predict the subsequent development of this complication. The clinical data and histopathology of 25 patients who eventually developed clinical HEC were compared with a control group of 25 age- and sex-matched patients with Hirschsprung's disease (HD) but with no clinical HEC either preoperatively or postoperatively. The histopathologic findings of tissue obtained by rectal biopsy or during laparotomy were graded from 0 to V according to severity and compared with the eventual clinical course. This study showed that (1) histopathologic findings of HEC appear to predict the clinical development, but not the severity, of future episodes of clinical HEC; (2) a histological grade of ≥II (≥2 crypt abscesses per high power field) should raise suspicion for subsequent occurrence of HEC, whereas a grade of ≥III (multiple crypt abscesses) places a child at high risk for development of clinical HEC; and (3) contrary to what is generally though, histopathologic changes of HEC occur in both ganglionic and aganglionic segments. Based on these findings, it is recommended that histopathologic documentation of HEC and its grade should be an integral part of the tissue diagnosis of HD. |
Author | Coran, Arnold G Heidelberger, Kathleen P Teitelbaum, Daniel H Elhalaby, Essam A |
Author_xml | – sequence: 1 givenname: Essam A surname: Elhalaby fullname: Elhalaby, Essam A organization: Section of Pediatric Surgery, C.S. Mott Children's Hospital, Ann Arbor, MI, USA – sequence: 2 givenname: Daniel H surname: Teitelbaum fullname: Teitelbaum, Daniel H organization: Section of Pediatric Surgery, C.S. Mott Children's Hospital, Ann Arbor, MI, USA – sequence: 3 givenname: Arnold G surname: Coran fullname: Coran, Arnold G organization: Section of Pediatric Surgery, C.S. Mott Children's Hospital, Ann Arbor, MI, USA – sequence: 4 givenname: Kathleen P surname: Heidelberger fullname: Heidelberger, Kathleen P organization: Section of Pediatric Surgery, C.S. Mott Children's Hospital, Ann Arbor, MI, USA |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/7472925$$D View this record in MEDLINE/PubMed |
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Snippet | Enterocolitis associated with Hirschsprung's disease (HEC) remains a major source of morbidity and even mortality, both before and after definitive surgical... |
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SubjectTerms | Abscess - pathology Biopsy Case-Control Studies Child Colon - innervation Colon - pathology Diarrhea - physiopathology Enterocolitis - complications Enterocolitis - pathology Enterocolitis - physiopathology Female Follow-Up Studies Forecasting Ganglia - pathology Hirschsprung Disease - complications Hirschsprung Disease - pathology Humans Intestinal Mucosa - innervation Intestinal Mucosa - pathology Laparotomy Male Mucins Necrosis Rectum - pathology Retrospective Studies Shock - physiopathology Single-Blind Method Ulcer - pathology |
Title | Enterocolitis associated with Hirschsprung's disease: A clinical histopathological correlative study |
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