AUTHOR=Yang Jixin , Zhu Tianqi , Wu Xiaojuan , Wei Mingfa , Wang Guo , Feng Jiexiong 

TITLE=Colonoscopic Diagnosis of Postoperative Gastrointestinal Bleeding in Patients With Hirschsprung's Disease

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 9 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.672767

DOI=10.3389/fped.2021.672767

ISSN=2296-2360

ABSTRACT=Aim: Postoperative lower gastrointestinal bleeding in children with Hirschsprung’s Disease (HSCR) is a non-specific symptom, which may be caused by various etiology. Our current study aims to use colonoscopy to help diagnose the causes of postoperative hematochezia and to analyze the feasibility, accuracy and safety.
Methods: Twenty-four patients with HSCR with postoperative lower gastrointestinal bleeding or occult blood in the stool were enrolled in this study. The information of postoperative onset duration, age at examination, accompanied symptoms were collected. After bowel preparation, all patients underwent colonoscopy. According to the visual findings, mucosal biopsy was performed and pathological diagnosis were given. Further treatment was determined according to the visual findings of colonoscopy and pathological diagnosis. All patients were followed up for 6 months including therapeutic outcomes and recurrence of symptoms. 
Results: The mean onset duration was (221.3 ± 216.8) days postoperatively (ranging from 25 to 768 days). The mean age at examination was (41.0 ± 29.4) months. There was no significant difference in the onset days among the groups (all, p>0.05). Based on visual and pathological findings, there were 11 cases of HSCR associated enterocolitis (HAEC), 4 cases of anastomotic leakage, 7 cases of anastomotic inflammation, 1 case of juvenile polyp and 1 case of inflammatory pseudopolyp. Intraluminal saline irrigation, thrombin treatment, colorectal polyp electrocision were performed according to intraoperative diagnosis. Patients with HEAC and anastomotic inflammation underwent antibiotics therapy and colorectal irrigation. Patients with leakage underwent reoperation. The highest incidence of accompanied symptoms of diarrhea and fever existed in HEAC group (p=0.02) and leakage group (p=0.02) respectively. No perforation or aggravated bleeding occurs in any patients. All patients gained uneventful recovery during follow-up period.
Conclusions: Colonoscopy is a safe, accurate and timely examination for HSCR patients with postoperative lower gastrointestinal bleeding. The visual findings and biopsy provide accurate diagnosis and direct treatment for this group of patients.