Review of management of hirschsprung`s diseases at the Kenyatta National Hospital (January 1991 - December 2000)

Abstract

A retrospective study covering 10 years (January 1991 to December 2000) was carried out on the management of Hirschsprung's disease at Kenyatta National Hospital. Ninety-three cases certified the inclusion criteria as underlined below. There were 75 males (80.6%) and 18 females (19.4%). The age at histological diagnosis ranged between 14 days to 13 years with the majority (50.4%) being in the age range of 1 to 5 years. The majority of patients were operated in age range of 1 to 5 years (59.1%). No patient below the age of one month was operated. The most common presenting complaints were abdominal distension, constipation and failure to pass meconium within 48 hours of birth. All patients had a histological diagnosis of the disease. The other common diagnostic methods used were laparatomy and serial biopsy (75.3%) and barium enema radiography (69.9%). Most patients (93.5%) had short segment aganglionosis of the colon. The most favoured method for the definitive operation in the treatment of Hirschsprung's disease was the Swenson's procedure (52.6%) while only one patient underwent the Duhamel operation. The commonest preoperative complication seen in these patients was intermittent or complete intestinal obstruction (77.5%). There were many postoperative complications encountered in the first 30 days, after the definitive operation, the commonest being wound infection accounting for 14.0% and the least common being intra-abdominal or pelvic abscess. One patient died within 30 days after operation in 1994. Anastomotic stenosis and recurrence of symptoms accounted for 25.9% of the late post-operative complications. They were the reason for re¬operations which was done in 21 patients (22.6%). The average postoperative hospital stay was 11 days.