Treatment and postoperative complication of 420 patients with congenital megacolon

OBJECTIVE

Hirschprung's disease is still one of the most important problems of pediatric surgery and its treatment has its own different complications and difficulties. Therefore, pediatric surgeons use different methods in each case. The objective of this study was to review the advantages and disadvantages of the Swenson's procedure over the past 20-years.

METHODS

In this survey, we reported 420 patients who in a 20-year interval (from 1981-2000) with the net diagnosis of Hirschprung's disease, were admitted to the pediatric surgery ward of Taleghani Medical Center, Tehran, Iran and operated on by Swenson's procedure. This survey has been carried out in 2 parts with descriptional method using patients' files and analytical method by using patients' observation and questionnaires. In the first step, they were 420 patients and in second step 216 patients were studied and the results of the first 10 years (190 cases) and the results of the second 10 years (230 cases) were analyzed alone and compared with each.

RESULTS

The results revealed wound infection in 17 cases in the first 10 years (14.2%), with18 cases in the second (7.9%) giving a mean of 10.7%. Anastomosis leakage was 6.8% in the first and 2.2% in the second 10 years with a mean of 4.2%. Septicemia was 3.6% in the first and 0.9% in the second period with a mean of 4%. Intestinal obstruction was 4.2% in the first and 2.1% in the second 10 years with a mean of 3%. There was no mortality during the surgery and for one month after. The results of late complications are: rectal anastomosis stricture, 13% in the first and 3% in the second 10 years with a mean of 7.6%; inguinal hernia of 1.6% in the first and 0.4% in the second period with a mean of 1% and finally, the death rate due to enterocolitis was 1.6% in the first and 0.9% in the second 10 years. Altogether, 87% of patients and their parents were satisfied with bowel habits after operation; 10% were relatively satisfied and 3% were not satisfied at all. Age distribution at the time of diagnosis: 50% of 0-1 months; 23% of 1-12 months and 27% were above one-year-old. Three hundred and eleven patients (74%) were male and 109 (26%) were female. The youngest patient was 3-days-old and the oldest was a 14-year and 3-month-old boy. The most common denerved part of the intestine was sigmoid colon with 54.4% prevalence.

CONCLUSION

Our results show that Swenson's method is a successful procedure in the treatment of Hirschprung's disease.

Acute pericarditis in childhood: a 10-year experience

Twenty children, aged 6 months to 13 years, with acute pericarditis admitted between 1987 and 1997 to a university hospital were analyzed retrospectively for their etiology, presentation, management, and prognosis. The most common types of pericarditis were purulent (40%), collagen vascular disease (30%), viral (20%), and neoplastic disease (10%). Most children presented with chest pain, fever, and tachypnea, but cardiac tamponade was not seen in any children. Staphylococcus aureus was the most frequent causative organism of purulent pericarditis and septic arthritis was the most common concurrent infection in the patients. Surgical drainage was performed for 11 cases, 9 underwent subxiphoid pericardial window, and 2 underwent thoracotomy. There was no constrictive pericarditis or reaccumulation of fluid after surgery. Two children died, one of staphylococcal septicemia and the other had a malignant mediastinal tumor. The remaining 18 made a complete recovery. We conclude that subxiphoid pericardial drainage is a simple, safe, and quick procedure and can be done easily in general hospitals by pediatric surgeons. The expensive facilities of cardiac surgeries are not needed.