Purpose

To highlight the utility of Colorectal Nurse Specialist (CNS) supervised parental administration of rectal washouts in the management of Hirschsprung’s disease (HD).

Methods

Retrospective case note review of HD patients treated at a tertiary children’s hospital in United Kingdom from January 2011 to December 2022. Data collected included demographics, complications, enterocolitis, obstructive symptoms and stomas. Primary pull-through (PT) is done 8–12 weeks after birth. Parental expertise in performing rectal washouts at home is ensured by our CNS team before and after PT.

Results

PT was completed in 69 of 74 HD patients. Rectal washouts were attempted on 63 patients before PT. Failure of rectal washout efficacy necessitated a stoma in four patients (6.4%).

Of the 65 patients who had PT and stoma closed, three (4.5%) required a further stoma over a mean follow-up period of 57 months (Range 7–144 months). Two of these had intractable diarrhoea due to Total Colonic Aganglionosis (TCA). One patient (1.5%) had unmanageable obstructive symptoms requiring re-diversion. Hirschsprung-associated enterocolitis (HAEC) requiring hospital admission occurred in 14 patients (21%).

Conclusion

Our stoma rates are lower compared to recent UK data. This could potentially be due to emphasis on parental ability to perform effective rectal washouts at home under CNS supervision.

中文翻译：

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结直肠专科护士监督家长进行直肠冲洗对先天性巨结肠的影响：回顾性评价

目的

强调结直肠专科护士 (CNS) 监督家长进行直肠冲洗在先天性巨结肠 (HD) 治疗中的作用。

方法

对 2011 年 1 月至 2022 年 12 月在英国一家三级儿童医院接受治疗的 HD 患者进行回顾性病例记录审查。收集的数据包括人口统计、并发症、小肠结肠炎、梗阻症状和造口。初次拉穿 (PT) 在出生后 8-12 周进行。我们的 CNS 团队在 PT 前后确保家长在家里进行直肠冲洗的专业知识。

结果

74 名 HD 患者中有 69 名完成了 PT。 PT 前对 63 名患者进行了直肠冲洗尝试。 4 名患者 (6.4%) 因直肠冲洗效果失败而需要造口。

在 65 名接受 PT 和造口闭合的患者中，有 3 名 (4.5%) 在平均 57 个月的随访期间（范围 7-144 个月）需要进一步造口。其中两人因完全结肠无神经节病（TCA）而患有顽固性腹泻。一名患者 (1.5%) 出现难以控制的阻塞症状，需要重新改道。 14 名患者 (21%) 发生需要入院的先天性巨结肠相关小肠结肠炎 (HAEC)。

结论

与英国最近的数据相比，我们的造口率较低。这可能是由于强调父母在中枢神经系统监督下在家中进行有效直肠冲洗的能力。