RECURRENT HIRSCHSPRUNG-ASSOCIATED ENTEROCOLITIS

Introduction. Hirschsprung-associated enterocolitis is one of the most dangerous complications of Hirschsprung's disease. Cases of recurrent enterocolitis after surgery occur with different methods of surgical treatment, at any age of the patient. The complexity of the treatment of Hirschsprung-associated enterocolitis was the basis for conducting a study and outlining ways to solve the problem. Aim: to develop therapeutic and diagnostic measures for recurrent enterocolitis in patients with GD after bowel pull-down surgery. Materials and methods. From 2010 to 2024, 112 patients under 3 years of age with GD were operated on in the Republican Scientific and Practical Center for Pediatric Surgery using the transanal endorectal bowel pull-down (TERT) method. During this period, we observed 25 cases of postoperative enterocolitis. Of these, 16 patients had recurrent postoperative enterocolitis. Results. The causes of recurrent postoperative enterocolitis in Hirschsprung's disease in patients operated on before the age of 3 years were analyzed. The use of the posterior muscle cuff excision method during transanal endorectal bowel pull-down surgery (in 2015) led to a decrease in the number of postoperative enterocolitis associated with colostasis (the total number of enterocolitis decreased from 34 % in the period 2010–2014 to 14.3 % in the period 2020–2024). An algorithm has been developed to identify the causes of recurrent Hirschsprung-associated enterocolitis, as well as a set of therapeutic measures if they are detected. In patients with recurrent Hirschsprung-associated enterocolitis, autoimmune processes associated with inflammation are triggered in the intestinal wall. Conclusion. A decrease in the number of enterocolitis can be achieved by using modern methods of surgical treatment of Hirschsprung’s disease, timely detection of the anatomical cause (stenosis or residual aganglionosis) and its elimination, adequate postoperative treatment, the appointment of preventive treatment for Hirschsprung-associated enterocolitis and long-term follow-up of patients operated on for Hirschsprung’s disease.