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Konishi K, Tsuda T, Togashi Y, Kawawaki T, Takimoto A, Takeuchi Y. Congenital multiple colonic atresias in the sigmoid colon and upper rectum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2022.102555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Neazy SA, Basamh HA, Kamal J, Alghamdi RM, Bin Suayb AS. Staged Repair Using Modified Bishop-Koop Procedure in Complicated Congenital Colonic Atresia in a Neonate. Cureus 2021; 13:e18149. [PMID: 34703687 PMCID: PMC8529410 DOI: 10.7759/cureus.18149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 11/05/2022] Open
Abstract
Colonic atresia (CA) is the rarest type of intestinal atresia and is defined as an obstruction in the large intestinal lumen. This is a rare case presentation of a four-day-old full-term female patient presented with signs and symptoms of intestinal obstruction. Investigation revealed that she had complicated CA located in the splenic flexure. Laparotomy and colostomy were done on the patient. About two months later, she was admitted for stoma closure, which was converted to modified Bishop-Koop stoma. Lastly, the patient underwent a successful stoma closure. Upon one month of follow-up, the patient's condition has markedly improved and the wound healed well without any complications.
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Affiliation(s)
- Sultan A Neazy
- Pediatric Surgery, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
| | - Hisham A Basamh
- Pediatric Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| | - Jamal Kamal
- Pediatric Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| | - Rana M Alghamdi
- Pediatric Surgery, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
| | - Alanoud S Bin Suayb
- Surgery, College of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh, SAU
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El-Asmar KM, Abdel-Latif M, El-Kassaby AHA, Soliman MH, El-Behery MM. Colonic Atresia: Association with Other Anomalies. J Neonatal Surg 2016; 5:47. [PMID: 27896155 PMCID: PMC5117270 DOI: 10.21699/jns.v5i4.422] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 08/13/2016] [Indexed: 11/26/2022] Open
Abstract
Background: Colonic atresia (CA) is a rare form of congenital intestinal atresia. Although CA may be isolated, it is more commonly reported in literature in association with other congenital anomalies.
Materials and Methods: This study is a review of prospectively collected data of all the patients with colonic atresia presented to our center (Ain Shams University) during 2008 to 2016.
Results: Twelve patients were enrolled in this study. The atresia was of type I in one case, type II in four cases, type IIIa in six cases, type IV in one case. These cases accounted for 4.9 % of intestinal atresias managed in our center during the same period. Five cases were isolated CA, while the other seven cases had associated abdominal congenital anomalies (exomphalos, Hirschsprung's disease, imperforate anus, closing gastroschisis, colonic duplication, and multiple small bowel atresia in two cases). The management in ten cases was by staged procedure with creation of a temporary stoma initially, while primary anastomosis was established in two cases. We had two cases with delayed presentations, one missed diagnosis, and three mortalities in this series.
Conclusions: The low incidence of CA may result in delay in the diagnosis and management. Hirschsprung's disease should be excluded in every case of colonic atresia. Early diagnosis and proper surgical management is essential for good prognosis.
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Park J. Delayed diagnosis of Hirschsprung's disease associated with colonic atresia and multiple anomalies: Report of a case and review of the literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Lim IIP, Durbin J, Tomita S. Colonic stenosis in infant with connective tissue disorder. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Peres LC, Cohen MC. Sudden unexpected early neonatal death due to undiagnosed Hirschsprung disease enterocolitis: a report of two cases and literature review. Forensic Sci Med Pathol 2013; 9:558-63. [PMID: 23842858 DOI: 10.1007/s12024-013-9465-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2013] [Indexed: 10/26/2022]
Abstract
Hirschsprung enterocolitis (HEC) is an uncommon, albeit well known, complication of Hirschsprung disease (HD). It is multifactorial and can appear in different age groups, but is particularly important in the neonatal period where it is characteristically seen in full-term neonates. Two cases of HEC are reported that were diagnosed at post-mortem examination, which presented as early sudden neonatal death, with a review the literature on fatal Hirschsprung enterocolitis. Case 1 was a 4-day old male neonate who was found unwell, struggling to breath, and with green vomitus. He was taken to hospital and pronounced dead a short time later. According to the parents meconium was passed on the first day. Post-mortem examination demonstrated necrotizing enterocolitis with isolated bowel perforation. Histology disclosed unsuspected HD. Case 2 was a 2-day old male neonate who was found wheezing with green vomitus. He arrived floppy, cyanosed, and in shock at the hospital and died a few hours later. Meconium was not passed, according to the parents. Post-mortem examination revealed necrotizing enterocolitis. There was also recto-sigmoidal aganglionosis and acetylcholinesterase staining confirmed HD. HEC is a multifactorial and sometimes recurrent complication of HD which characteristically develops in full-term neonates. Presentation with early sudden neonatal death is rare but should be considered in the diagnostic work-up of sudden deaths in this age group.
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Affiliation(s)
- Luiz Cesar Peres
- Department of Histopathology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, S10 2TH, UK,
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Abstract
PURPOSE Proximal colonic atresia often results in a marked discrepancy of the atretic ends presenting a technical challenge for restoration of bowel continuity. We review our series of colonic atresia patients with particular reference to the techniques for restoring bowel continuity. METHODS Case notes of all patients diagnosed with colonic atresia and admitted to our unit between 1997 and 2011 were reviewed. RESULTS There were 13 patients with a median gestational age of 39 weeks. Location of the atresia was ascending colon (n = 1), hepatic flexure (n = 9), proximal transverse colon (n = 2) and sigmoid colon (n = 1). The primary procedure was: primary anastomosis (n = 1), right hemicolectomy followed by ileo-colic anastomosis (n = 2), right hemicolectomy and stoma formation (n = 3). Six patients underwent stoma formation, of which five subsequently had a right hemicolectomy at a later procedure. In total, 10/12 patients required right hemicolectomy to facilitate restoration of bowel continuity. Median time to full feeds was 11 days (4-46). Median follow up time was 11 months (22 days-5.6 years). CONCLUSION A temporising stoma does not reduce the discrepancy in the calibre of the atretic ends in proximal colonic atresia. Right hemicolectomy and ileo-colic anastomosis should therefore be considered at the initial surgery.
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Affiliation(s)
- Richard J England
- Paediatric Surgery Unit, Sheffield Children's Hospital NHS Trust, Sheffield, UK.
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Hsu CT, Wang SS, Houng JF, Chiang PJ, Huang CB. Congenital colonic atresia: report of one case. Pediatr Neonatol 2010; 51:186-9. [PMID: 20675245 DOI: 10.1016/s1875-9572(10)60035-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 07/13/2009] [Accepted: 08/03/2009] [Indexed: 11/30/2022] Open
Abstract
Colonic atresia is a very rare cause of intestinal obstruction, and surgical management is the mainstay of therapy. A case of congenital colonic atresia is reported in a full-term neonate who presented with delayed passage of meconium, abdominal distention and bilious vomiting. The present case and the pertinent literature are discussed, with an emphasis on surgical management.
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Affiliation(s)
- Chieh-Teng Hsu
- Department of Pediatrics, Chang Gung Memorial Hospital at Chia-Yi, Chia-Yi, Taiwan
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Dassinger M, Jackson R, Smith S. Management of colonic atresia with primary resection and anastomosis. Pediatr Surg Int 2009; 25:579-82. [PMID: 19517120 DOI: 10.1007/s00383-009-2401-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Historically, the majority of patients with colonic atresia have been managed by ostomy creation at the time of initial operation; conversely, we have tended to treat the atresia with resection and anastomosis. The purpose of this study is to determine the rate of concomitant Hirschsprung's disease and to identify potential morbidity associated with primary repair. METHODS After IRB approval (#105825), charts of patients identified by ICD-9 code as having colonic atresia, who were admitted to our institution between 1993 and 2008 were, retrospectively, reviewed. Particular attention was paid to demographic data, comorbidities, operative therapy, and complications. Continuous variables were compared using an unpaired t test. A P value of <0.05 was considered significant. RESULTS Twelve newborns with colonic atresia were identified. Two babies were managed initially with ostomy, both of whom had gastroschisis; primary repair was performed on ten, with two undergoing simultaneous rectal biopsy. No anastomotic complications occurred and there were no mortalities. One patient experienced self-limited malabsorption symptoms after repair. No cases of Hirschsprung's disease were detected. CONCLUSIONS Uncomplicated colonic atresia can be managed by primary repair with little morbidity.
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Garcia-Barceló MM, Lau DK, Ngan ES, Leon TY, Liu T, So M, Miao X, Lui VC, Wong KK, Ganster RW, Cass DT, Croaker GDH, Tam PK. Evaluation of the NK2 homeobox 1 gene (NKX2-1) as a Hirschsprung's disease locus. Ann Hum Genet 2007; 72:170-7. [PMID: 18081917 DOI: 10.1111/j.1469-1809.2007.00403.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hirschsprung's disease (HSCR, colonic aganglionosis) is an oligogenic entity that usually requires mutations in RET and other interacting loci. Decreased levels of RET expression may lead to the manifestation of HSCR. We previously showed that RET transcription was decreased due to alteration of the NKX2-1 binding site by two HSCR-associated RET promoter single nucleotide polymorphisms (SNPs). This prompted us to investigate whether DNA alterations in NKX2-1 could play a role in HSCR by affecting the RET-regulatory properties of the NKX2-1 protein. Our initial study on 86 Chinese HSCR patients revealed a Gly322Ser amino acid substitution in the NKX2-1 protein. In this study, we have examined 102 additional Chinese and 70 Caucasian patients and 194 Chinese and 60 Caucasian unselected, unrelated, subjects as controls. The relevance of the DNA changes detected in NKX2-1 by direct sequencing were evaluated using bioinformatics, reporter and binding-assays, mouse neurosphere culture, immunohistochemistry and immunofluorescence techniques. Met3Leu and Pro48Pro were identified in 2 Caucasian and 1 Chinese patients respectively. In vitro analysis showed that Met3Leu reduced the activity of the RET promoter by 100% in the presence of the wild-type or HSCR-associated RET promoter SNP alleles. The apparent binding affinity of the NKX2-1 mutated protein was not decreased. The Met3Leu mutation may affect the interaction of NKX2-1 with its protein partners. The absence of NKX2-1 expression in mouse but not in human gut suggests that the role of NKX2-1 in gut development differs between the two species. NKX2-1 mutations could contribute to HSCR by affecting RET expression through defective interactions with other transcription factors.
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Affiliation(s)
- M-M Garcia-Barceló
- Division of Paediatric Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine of the University of Hong Kong, Hong Kong SAR, China.
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Garcia-Barceló MM, Lau DKC, Ngan ESW, Leon TYY, Liu TT, So MT, Miao XP, Lui VCH, Wong KKY, Ganster RW, Cass DT, Croaker GDH, Tam PKH. Evaluation of the thyroid transcription factor-1 gene (TITF1) as a Hirschsprung's disease locus. Ann Hum Genet 2007; 71:746-54. [PMID: 17640327 DOI: 10.1111/j.1469-1809.2007.00384.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hirschsprung's disease (HSCR, colonic aganglionosis) is an oligogenic entity that usually requires mutations in RET and other interacting loci. Decreased levels of RET expression may lead to the manifestation of HSCR. We previously showed that RET transcription was decreased due to alteration of the TITF1 binding site by two HSCR-associated RET promoter single nucleotide polymorphisms (SNPs). This prompted us to investigate whether DNA alterations in TITF1 could play a role in HSCR by affecting the RET-regulatory properties of the TITF1 protein. Our initial study on 86 Chinese HSCR patients revealed a Gly322Ser amino acid substitution in the TITF1protein. In this study we have examined an additional 102 Chinese and 70 Caucasian patients, and 194 Chinese and 60 Caucasian unselected, unrelated, subjects as controls. The relevance of the DNA changes detected in TITF1 by direct sequencing were evaluated using bioinformatics, reporter and binding-assays, mouse neurosphere culture, immunohistochemistry and immunofluorescence techniques. Met3Leu and Pro48Pro were identified in 2 Caucasian patients and 1 Chinese patient, respectively. In vitro analysis showed that Met3Leu reduced the activity of the RET promoter by 100% in the presence of the wild-type or HSCR-associated RET promoter SNP alleles. The apparent binding affinity of the TITF1 mutated protein was not decreased. The Met3Leu mutation may affect the interaction of TITF1 with its protein partners. The absence of Titf1 expression in mouse gut but not in human gut suggests that the role of TITF1 in gut development differs between the two species. TITF1 mutations could contribute to HSCR by affecting RET expression through defective interactions with other transcription factors.
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Affiliation(s)
- Maria-Mercè Garcia-Barceló
- Division of Paediatric Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine of the University of Hong Kong, Hong Kong SAR, China
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Draus JM, Maxfield CM, Bond SJ. Hirschsprung's disease in an infant with colonic atresia and normal fixation of the distal colon. J Pediatr Surg 2007; 42:e5-8. [PMID: 17270533 DOI: 10.1016/j.jpedsurg.2006.10.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The coexistence of colonic atresia and Hirschsprung's disease presents a diagnostic and therapeutic challenge. Colonic atresia is quickly recognized, and the majority of patients are diverted shortly after birth. The diagnosis of coincident Hirschsprung's disease usually is made after anastomotic failure after restoration of intestinal continuity. A recent compilation of these patients has suggested that Hirschsprung's disease may be predicted on the basis of nonfixation of the colon distal to the atresia. However, we recently cared for an infant with transverse colonic atresia and total colonic aganglionosis associated with normal orientation and fixation of the distal colon.
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Affiliation(s)
- John M Draus
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40202, USA
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Lauwers P, Moens E, Wustenberghs K, Deprettere A, Ruppert M, Balliu L, Hubens G, Vaneerdeweg W. Association of colonic atresia and Hirschsprung's disease in the newborn: report of a new case and review of the literature. Pediatr Surg Int 2006; 22:277-81. [PMID: 16021458 DOI: 10.1007/s00383-005-1456-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2004] [Indexed: 10/25/2022]
Abstract
Colonic atresia (CA) is an infrequent cause of lower gastrointestinal obstruction in the neonate. Coexistence with aganglionosis of the colon (Hirschsprung's disease) has been reported but is generally not recognized in the neonatal period. We report another case and present a review of the literature. A boy with a lower gastrointestinal obstruction, caused by a CA type III, had creation of a proximal colostomy and a distal mucous fistula on the 1st day of life. In the preoperative work-up before restoring the continuity, rectal suction biopsies revealed the presence of Hirschsprung's disease. When the boy was 6 months old, a distal colectomy and reanastomosis were done. Creation of a colostomy and reanastomosis in a second procedure is recommended for treating a type III CA unless distal aganglionosis has been ruled out.
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Affiliation(s)
- P Lauwers
- Department of Abdominal and Pediatric Surgery, University Hospital of Antwerp, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.
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Abstract
BACKGROUND/PURPOSE Colonic atresia (CA) is one of the rarest causes of neonatal intestinal obstructions, and no large series can be reported. Therefore, we did perform a retrospective clinical trial to delineate our CA cases and carry out a literature survey. METHODS We reviewed the charts of CA cases treated in our center between 1992 and 2002. We aimed to collect all reported cases in Medline, and personal communications with the authors of published series were used to reach the missing data. RESULTS The chart review revealed 9 newborns with CA treated in our center (6 cases of type III, 2 cases of type II, and 1 case of type IV). These accounted for 3.7% of all gastrointestinal atresias managed in our center. Of the CA cases, 3 were isolated and 6 had at least one or more associated congenital anomalies. The preferred surgical technique at the initial treatment of CA was performing a proximal stoma and distal mucous fistula in an average of postnatal 59.4 hours. The literature survey enabled us to reach 224 cases of CA, including our cases. CONCLUSIONS Because of the low incidence of CA, delay in diagnosis and treatment may occur. The mortality is statistically higher when the surgical management is performed after 72 hours of age. However, the prognosis of CA is satisfactory if diagnosis and surgical management could be made promptly and properly.
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Affiliation(s)
- Barlas Etensel
- Department of Pediatric Surgery, Adnan Menderes University, 09100 Aydin, Turkey.
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Shahar E, Shinawi M. Neurocristopathies presenting with neurologic abnormalities associated with Hirschsprung's disease. Pediatr Neurol 2003; 28:385-91. [PMID: 12878302 DOI: 10.1016/s0887-8994(03)00010-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Neurocristopathies are a group of diverse disorders resulting from defective growth, differentiation, and migration of the neural crest cells. Hirschsprung's disease, namely aganglionic megacolon, is the consequence of defective migration of neural crest cells on to the colonic submucosa and is therefore considered a neurocristopathy. We report on four children in whom was diagnosed a neurocristopathy, associating Hirschsprung's disease with a wide spectrum of neurologic abnormalities. The patients included two children presenting the phenotypic features of the Goldberg-Shprintzen syndrome: distinct dysmorphic facial features, microcephaly, and mental retardation, along with agenesis of the corpus callosum and cortical malformations associated with intractable seizures in one child. The third newborn presented with the Haddad syndrome: short-segment Hirschsprung's disease associated with the congenital central hypoventilation syndrome requiring permanent artificial ventilation. In the fourth child, absence of the corpus callosum was associated with mild dysmorphic features, borderline cognitive abilities, and attention-deficit disorder. Therefore, awareness of a possible neurocristopathy associated with neurologic abnormalities should be taken into account in any patient newly diagnosed with Hirschsprung's disease to detect the abnormalities early and promptly manage them. A thorough neurologic examination and a developmental assessment, including magnetic resonance imaging of the brain and electroencephalography, should be performed for any child presenting with an aganglionic megacolon, especially those presenting with seizures, developmental delay, or even congenital hypoventilation.
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Affiliation(s)
- Eli Shahar
- Child Neurology Unit and Epilepsy Service, Meyer Children Hospital, Rambam Medical Center, Haifa 31096, Israel
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Seo T, Ando H, Watanabe Y, Harada T, Ito F, Kaneko K, Katsuno S, Marui Y, Ochiai K. Colonic atresia and Hirschsprung's disease: importance of histologic examination of the distal bowel. J Pediatr Surg 2002; 37:E19. [PMID: 12149719 DOI: 10.1053/jpsu.2002.34495] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hirschsprung's disease associated with colonic atresia is rare. A boy with colonic atresia at the hepatic flexure who had a colostomy in the neonatal period suffered from severe constipation after definitive colocolostomy. Hirschsprung's disease was diagnosed with anorectal manometry and rectal mucosal biopsy, and a Duhamel-Ikeda's pull-through procedure was performed. Aganglionosis of the entire distal colon was seen, and intrauterine torsion of the dilated proximal colon followed by necrosis and absorption was suspected as the cause of colonic atresia. Colonic atresia should be generally screened for Hirschsprung's disease with a rectal biopsy. J
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Affiliation(s)
- Takahiko Seo
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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