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Minerva Pediatrica 2019 Mar 21

DOI: 10.23736/S0026-4946.19.05487-2

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Non-standard approach to infants and children with megacolon: laparotomy and endorectal pull-through (ERPT) for diagnosis and treatment in difficult countries with low resources in a non-profit setting: return to the past Soave's ERPT

Girolamo MATTIOLI 1, 2, Louisma OSNEL 3, Michela C. WONG 1, 2 , Federico PALO 1, 2, Maria G. FATICATO 1, 2, Paolo PETRALIA 1

1 Paediatric Surgery Unit, Giannina Gaslini Children Hospital and Research Institute, Genoa, Italy; 2 DINOGMI, University of Genoa, Genoa, Italy; 3 Paediatric Surgery Unit, Saint Damien Children Hospital, Port-au-Prince, Haiti


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BACKGROUND: Hirschsprung's disease is an important cause of pediatric constipation with high risk of bacterial enterocolitis. Its diagnosis is histological and the suction biopsy is the gold standard. In resource-limited countries, the main diagnostic exam is the contrast enema and mini-invasive surgery lacks. We present the management of a cohort of patients with megacolon in Haiti, a low-resource country.
METHODS: Children with megacolon and fecal impaction admitted at St Damien Children Hospital in Port-Au-Prince in June, August and December 2017 were included. We considered only patients with an evident transition zone on contrast enema who underwent endorectal pull-through (ERPT). Short term complications were recorded.
RESULTS: Twenty children with clinical megacolon were admitted, eleven were included in the study. No suction rectal biopsy and intraoperative histological evaluation were performed. In ten children a Soave ERPT with anastomosis at 5POD was performed, in the other case a Boley primary anastomosis was preferred. One patient complicated with a peritonitis. No major complications were recorded. Colostomy was not considered a good option.
CONCLUSIONS: In developing countries, Soave ERPT with definitive anastomosis after few days could be considered a valid option. Colostomy is suggested only in case of scant general conditions or bad colon appearance.


KEY WORDS: Hirschsprung - HD - Low-resources country - Resource-limited country - Soave ERPT

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