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

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