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Experience with Hirschsprung’s Disease at a Tertiary Hospital in Kenya
Abstract
BACKGROUND: Hirschsprung’s disease presents unique characteristics in Africans. Previous literature has reported high complication rates. We examined our single-institution experience with Hirschsprung’s disease (HD) to evaluate
outcomes related to the different phases of care.
STUDY DESIGN: Records were reviewed for children with HD managed during the years 2002 to 2006. Morbidities and mortalities were evaluated in relation to the different phases of
care. Categorical variables were compared using Chi-square analysis.
SETTING: Kenyatta National Hospital (KNH) a teaching and referral hospital, Nairobi, Kenya.
RESULTS: One hundred and twelve patients with clinical diagnosis of HD were evaluated. Eighty nine had histological confirmation of HD. Forty four (39%) were aged 30 days or below. Eighteen children were lost to follow up before definitive
diagnosis while a further 14 were lost after colostomy formation (before definitive surgery). Fifty six patients underwent definitive surgery (between one day and four years). Two had singlestage surgery while the rest had Swenson (52) and
Boley’s (2) endorectal pull-through after interim colostomies. Thirty nine of 69 patients (56.5%) developed complications related to colostomies or definitive care. Morbidity related to colostomy alone was 34.7% while that related to the
definitive surgery was 64.8%. There were sixteen deaths. The mean time to reversal for patients with colostomies was 23+12 months. Colostomy duration of more than one year was associated with more complications, increased duration of
hospital stay and overall length of management.
CONCLUSIONS: This retrospective review of a single-institution experience with treatment for HD has demonstrated a morbidity rate similar to other centres but a mortality rate higher than in
published literature. Only 39% of patients with HD present during the neonatal period in our environment. The long duration of colostomy is associated with complications, prolonged duration of treatment as well as significant losses to follow
up. A single-stage repair may expedite care and reduce the colostomy morbidity.
outcomes related to the different phases of care.
STUDY DESIGN: Records were reviewed for children with HD managed during the years 2002 to 2006. Morbidities and mortalities were evaluated in relation to the different phases of
care. Categorical variables were compared using Chi-square analysis.
SETTING: Kenyatta National Hospital (KNH) a teaching and referral hospital, Nairobi, Kenya.
RESULTS: One hundred and twelve patients with clinical diagnosis of HD were evaluated. Eighty nine had histological confirmation of HD. Forty four (39%) were aged 30 days or below. Eighteen children were lost to follow up before definitive
diagnosis while a further 14 were lost after colostomy formation (before definitive surgery). Fifty six patients underwent definitive surgery (between one day and four years). Two had singlestage surgery while the rest had Swenson (52) and
Boley’s (2) endorectal pull-through after interim colostomies. Thirty nine of 69 patients (56.5%) developed complications related to colostomies or definitive care. Morbidity related to colostomy alone was 34.7% while that related to the
definitive surgery was 64.8%. There were sixteen deaths. The mean time to reversal for patients with colostomies was 23+12 months. Colostomy duration of more than one year was associated with more complications, increased duration of
hospital stay and overall length of management.
CONCLUSIONS: This retrospective review of a single-institution experience with treatment for HD has demonstrated a morbidity rate similar to other centres but a mortality rate higher than in
published literature. Only 39% of patients with HD present during the neonatal period in our environment. The long duration of colostomy is associated with complications, prolonged duration of treatment as well as significant losses to follow
up. A single-stage repair may expedite care and reduce the colostomy morbidity.
