ENTEROCOLITIS FOLLOWING ENDORECTAL PULL-THROUGH PROCEDURE IN CHILDRENWITH HIRSCHSPRUNGS-DISEASE

The enterocolitis following a pull-through in Hirschsprung's disease c an be life-threatening and difficult to distinguish clinically from ga stroenteritis and post-operative complications. We reviewed retrospect ively the abdominal radiographs in our series to identify specific rad iographic characteristics of this syndrome in this population. A total of 55 episodes of enterocolitis with an abdominal series at presentat ion were located in the files of 43 patients following pull-through su rgery for Hirschsprung's disease. There were 15 abdominal series with other complications of Hirschsprung's disease and surgery (seven cases of small bowel obstruction, one of fistula, one of abscess, six of se vere constipation) and 71 surveillance follow-up studies. Radiographs were evaluated for bowel dilatation, air-fluid levels, intestinal cut- off sign, spiculation, and pneumatosis. The intestinal cut-off sign wi th two or more air-fluid levels had sensitivity of 68 % and specificit y of 83 %, with a positive predictive value of 0.71 and overall accura cy of 77 %. Our review of enterocolitis following pull-through in chil dren with Hirschsprung's disease concludes that the constellation of a n intestinal cut-off sign and at least two air-fluid levels on the abd ominal series strongly suggests the diagnosis.