icrobial studies of enterocolitis in Hirschsprung's disease

Enterocolitis in Hirschsprung's disease (HD) has been the most significant cause of morbidity and mortality in children suffering from this disorder. A variety of aetiologies have been postulated, including hypersensitivity to bacterial antigens, proximal colonic dilatation with secondary mucosal ischaemia, abnormalities of the mucosubstances within the colon, elevated prostaglandin El activity, and microbiological infections with pathogens such asClostridium difficile and rotavirus. Recent studies have shown that children with HD who are prone to the development of enterocolitis have abnormalities of their immunological status. Studies of the microbiological flora of the colon of children with HD showed no significant difference between children with uncomplicated HD, those who ran a complicated course with enterocolitis, and a control group with no gastro-intestinal pathology. Viral studies have recently implicated a rotavirus in the aetiology of this condition, thus compounding the problem of pinpointing any particular organism. Previous studies have shown that some children with HD can develop a potentially lethal pseudomembranous colitis even if there has been no previous exposure to antibiotic therapy. These are clearly the group in which otherwise commensalCl. difficile has a significant pathogenic role. In view of this multi-factorial infective aetiology, it is recommended that a high level of suspicion be kept and all children with HD who develop any of the signs or symptoms of enterocolitis should have a full microbiological infective screen, as any number of bacterial or viral organisms may be the causal factor.