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Adult Hirschsprung's disease

Results of the Duhamel's procedure

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Abstract

Eleven patients with adult Hirschsprung's disease were treated at Seoul National University Hospital (SNUH, 8 cases) and Chosun University Hospital (CUH, 3 cases) between 1985 and 1992. Of the 11 patients, seven were male. The age of the patients ranged from 11 to 30 years, and all presented with chronic constipation and recurrent faecal impactions that required periodic enemas and laxatives. The Duhamel's operation, as a single or staged procedure, was performed in all patients. Levels of aganglionosis in 9 patients were confined to the rectosigmoid colon (82%). There were three major post-operative complications. Two patients developed fistula-in-ano at the anastomotic site, and one patient developed ileus. However, these complications resolved with conservative management. The longterm results were excellent except for one patient who developed impotence. The mean frequency of bowel movements was usually once or twice a day without the aid of other treatments. Our results indicate that Duhamel's operation is a highly acceptable procedure in the management of adult Hirschsprung's disease.

Résumé

11 patients adultes porteurs d'une maladie de Hirschsprung ont été traités à l'Hôpital Universitaire National de Séoul (8 cas) et à l'Hôpital Universitaire de Chosun (3 cas) entre 1985 et 1992. Des 11 patients 7 étaient des sujets mâles. L'âge des patients variait de 11 à 30 ans et tous se présentaient avec une constipation chronique et des sujets mâles. L'âge des patients variait de 11 à 30 ans et tous se présentaient avec une constipation chronique et des impactions fécales récidivantes nécessitant des lavaments périodiques et la prise de laxatifs. L'opération de Duhamel en un temps ou en plusiers temps opératoires a été réalisée chez tous les patients. Le niveau du segment aganglionnaire était limité au rectosigmoïde chez 9 patients (82%). 3 complications postopératoires majeures sont à déplorer. 2 patients ont développé une fistule anale au niveau de la zone anastomotique et un patient a développé un iléus postopératoire. Ces complications toutefois se sont résolues par un traitement conservateur. Les résultats à long terme étaient excellents à l'exception d'un patient qui a développé une impuissance. La fréquence moyenne des exonérations était habituellement de une à deux exonérations quotidiennes sans recours à un traitement complémentaire autre. Nos résultats indiquent que l'opération de Duhamel est une intervention très satisfaisante dans le traitement dela maladie de Hirschsprung de l'adulte.

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References

  1. Ruysch F (1691) Observationum anatomico-chirurgicarum centuria. Amstelodami

  2. Hirschsprung H (1887) Stuhlträgheit Neugeborener in Folge von Dilatation und Hypertrophie des Colons. Jahrb Kinderh 27:1–7

    Google Scholar 

  3. Robertson HE, Kernohan JW (1938) The myenteric plexus in congenital megacolon. Proc Staff Meet Mayo Clin 13:123–125

    Google Scholar 

  4. Swenson O, Bill AH Jr (1948) Resection of rectum and rectosigmoid with preservation of the sphincter for benign spastic lesions producing megacolon: an experimental study. Surgery 24:212–220

    Google Scholar 

  5. Duhamel B (1964) Retrorectal and transanal pull-through procedure for the treatment of Hirschsprung's disease. Dis Colon Rectum 7:455–458

    Google Scholar 

  6. Soave F (1964) Hirschsprung's disease: a new surgical technique. Arch Dis Child 39:116–124

    Google Scholar 

  7. Steichen FM, Talbert JL, Ravitch MM (1968) Primary side-to-side colorectal anastomosis in the Duhamel operation for Hirschsprung's disease. Surgery 64:475–483

    Google Scholar 

  8. McCready RA, Beart RW Jr (1980) Adult Hirschsprung's disease: results of surgical treatment at Mayo Clinic. Dis Colon Rectum 23:401–407

    Google Scholar 

  9. Roslin JD, Bargan JA, Waugh JM (1950) Congenital megacolon in a man of 54 years of age: a report a case. Mayo Clin Proc 25:710–715

    Google Scholar 

  10. Kempton JJ (1954) Hirschsprung's disease in a man aged 23. Proc R Soc Med 47:545–546

    Google Scholar 

  11. Hamdy MH, Scobie WG (1984) Anorectal myectomy in adult Hirschsprung's disease: a report of six cases. Br J Surg 71:611–613

    Google Scholar 

  12. Fishbein RH, Handelsman JC, Schuster MM (1986) Surgical treatment of Hirschsprung's disease in adults. Surg Gynecol Obstet 163:458–464

    Google Scholar 

  13. Fairgrieve J (1964) Hirschsprung's disease in the adult. Br J Surg 50:506–514

    Google Scholar 

  14. Hiatt RB (1951) The surgical treatment of congenital megacolon. Ann Surg 133:321–329

    Google Scholar 

  15. Jennings PJ (1967) Megarectum and megacolon in adolescents and young adults: results of treatment at St. Mark's Hospital. Proc R Soc Med 60:7–8

    Google Scholar 

  16. Hughes ES, Hardy KJ, Cuthbertson AM (1969) Megacolon in adults. Dis Colon Rectum 12:190–192

    Google Scholar 

  17. Todd IP (1977) Adult Hirschsprung's disease. Br J Surg 64:311–312

    Google Scholar 

  18. Horovitz IL, Baier I (1974) An unusual case of aganglionic megacolon. Dis Colon Rectum 17:249–253

    Google Scholar 

  19. Lesser PB, El-Nahas AM, Lukl P, Andrews P, Schuler JG, Filtzer HS (1979) Adult-onset Hirschsprung's disease. JAMA 242:24–31

    Google Scholar 

  20. Hung WT, Chiang TP, Tsai YW, Wu TT, Chang CH, Lie HY, Chen CJ (1989) Adult Hirschsprung's disease. J Pediatr Surg 24:363–366

    Google Scholar 

  21. Wheatley MJ, Wesley JR, Coran AG, Polley TZ Jr (1990) Hirschsprung's disease in adolescents and adults. Dis Colon Rectum 33:622–629

    Google Scholar 

  22. Lee CM Jr (1956) Experience with the extended postoperative care of congenital megacolon. Am Surg 22:705–718

    Google Scholar 

  23. Swenson O (1957) Follow-up on 200 patients treated for Hirschsprung's disease during a ten-year period. Ann Surg 146:706–714

    Google Scholar 

  24. Briggs HC (1971) Aganglionic megacolon in adults. Conn Med 35:680–683

    Google Scholar 

  25. Madsen CM (1964) Hirschsprung's disease: congenital intestinal aganglionosis. Munksgaard, Copenhagen, pp 245

    Google Scholar 

  26. Ponka JL, Grodsinsky C, Brush BE (1972) Megacolon in teenaged and adult patients. Dis Colon Rectum 15:14–22

    Google Scholar 

  27. Marshall WH, Kutz JE (1962) Adult Hirschsprung's disease. J Ky Med Assoc 60:1156

    Google Scholar 

  28. Lockhart-Mummery HE (1967) Hirschsprung's disease in the adult. Acta Chir Belg 66[Suppl 2]:39–46

    Google Scholar 

  29. Metzger PP, Alvear DT, Arnold GC, Stoner RR (1987) Hirschsprung's disease in adults: report of a case and review of the literature. Dis Colon Rectum 21:113–117

    Google Scholar 

  30. Goto S, Ikeda K, Nagasaki A, Tomikiyo A, Kusaba M (1984) Hirschsprung's disease in an adult. Special reference to histochemical determination of the acetylcholinesterase activity. Dis Colon Rectum 27:319–320

    Google Scholar 

  31. Elliot MS, Todd IP (1985) Adult Hirschsprung's disease: results of the Duhamel procedure. Br J Surg 72:884–885

    Google Scholar 

  32. Starling JR, Croom RD III, Thomas CG Jr (1986) Hirschsprung's disease in young adults. Am J Surg 151:104–109

    Google Scholar 

  33. Natsikas NB, Sbarounis CN (1987) Adult Hirschsprung's disease. An experience with the Duhamel-Martin procedure with special reference to obstructed patients. Dis Colon Rectum 30:204–206

    Google Scholar 

  34. Luukkonen P, Heikkinen M, Hukuri K, Jarvinen H (1990) Adult Hirschsprung's disease: clinical features and functional outcome after surgery. Dis Colon Rectum 33:65–69

    Google Scholar 

  35. Lynn HB, van Heerden JA (1975) Rectal myectomy in Hirschsprung's disease: a decade of experience. Arch Surg 110:991–994

    Google Scholar 

  36. Soper RT, Miller FE (1968) Congenital aganglionic megacolon (Hirschsprung's disease): diagnosis, management, and complications. Arch Surg 96:554–561

    Google Scholar 

  37. Maglietta ED (1960) Congenital aganglionic megacolon in adults: a case report. Arch Surg 81:598–603

    Google Scholar 

  38. Grosfeld JL, Ballantine TVN, Csicsko JF (1978) A critical evaluation of the Duhamel operation for Hirschsprung's disease. Arch Surg 113:454–460

    Google Scholar 

  39. Kim WK, Park LW, Lee SC (1987) Hirschsprung's disease (congenital megacolon, intestinal aganglionosis) — an analysis of 214 cases during 1978–84 period. J Kor Surg Society 32:436–444

    Google Scholar 

  40. Ehrenpreis TH (1970) Hirschsprung's disease. In: Year Book, Medical Publishers, Chicago, pp 57

    Google Scholar 

  41. Ehrenpreis TH, Livaditus A, Okmian L (1966) Results of Duhamel's operation for Hirschsprung's disease. J Pediatr Surg 1:40–48

    Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Chosun University Hospital, Kwangju, Korea

    C. Y. Kim

  2. Department of Surgery, Seoul National University Hospital, 28, Youngon-dong, Chongno-gu, 110-744, Seoul, Korea

    J.-G. Park, K. W. Park, K. J. Park, M. H. Cho & W. K. Kim

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  1. C. Y. Kim
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  2. J.-G. Park
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  3. K. W. Park
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  4. K. J. Park
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  5. M. H. Cho
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  6. W. K. Kim
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Kim, C.Y., Park, JG., Park, K.W. et al. Adult Hirschsprung's disease. Int J Colorect Dis 10, 156–160 (1995). https://doi.org/10.1007/BF00298539

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