Does Hirschsprung-Associated Enterocolitis Differ in Children With and Without Down Syndrome?

J Surg Res. 2020 Jan:245:564-568. doi: 10.1016/j.jss.2019.06.086. Epub 2019 Aug 30.


Background: Children with Hirschsprung disease (HD) and Down syndrome (DS) are reported to experience a higher incidence of Hirschsprung-associated enterocolitis (HAEC) than those without DS, although whether their individual episodes are more severe is unknown.

Methods: A single-institution retrospective cohort study was performed on all patients with HD admitted with HAEC between 2009 and 2017. Patients were divided into two groups based on an associated diagnosis of DS, and demographics, clinical characteristics at presentation, and clinical outcomes were compared.

Results: Of 86 admissions for HAEC over the study period, 12 (14%) were for patients with DS. Patients admitted with and without DS were similar in terms of age (3.0 versus 2.6 y, P = 0.72), male gender (58% versus 77%, P = 0.17), and proportion with disease proximal to the left colon (9% versus 12%, P = 0.70). Patients admitted with DS were more likely to be tachycardic (75% versus 19%, P ≤ 0.001) and hypotensive (33% versus 7%, P = 0.01) at presentation and presented for treatment after a longer duration of symptoms than those without DS (84 versus 24 h, P = 0.001). Patients admitted with DS were more likely to require intensive care unit admission (58% versus 12%, P = 0.006) and received a longer course of antibiotics (13 d versus 7 d, P = 0.02). The length of stay was similar (6 versus 4 d, P = 0.34).

Conclusions: The results of our study suggest that patients with DS experience more severe episodes of HAEC. Ongoing study is needed to identify preventive strategies to decrease the morbidity of HAEC in children with HD and DS.

Keywords: Down syndrome (DS); Enterocolitis; Hirschsprung disease (HD); Hirschsprung-associated enterocolitis (HAEC); Outcomes; Trisomy 21 (T21).

MeSH terms

  • Adolescent
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Down Syndrome / complications*
  • Enterocolitis / diagnosis
  • Enterocolitis / epidemiology*
  • Enterocolitis / etiology
  • Female
  • Hirschsprung Disease / complications*
  • Humans
  • Incidence
  • Infant
  • Male
  • Retrospective Studies
  • Severity of Illness Index