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Ileal Atresia Mimicking Hirschsprung Disease on Contrast Study: A Case Report and Diagnostic Re-evaluation Anisa Ika Pratiwi; Ibnu Sina Ibrohim
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.770

The differentiation between congenital causes of neonatal bowel obstruction, such as ileal atresia and Hirschsprung disease, is paramount for appropriate surgical planning. While clinically similar, their radiological findings can overlap, creating significant diagnostic challenges. Ileal atresia is a congenital anomaly characterized by the incomplete development of the ileum, resulting in intestinal obstruction. The aim of this study is to highlight the limitations of contrast studies in neonatal bowel obstruction and to reinforce the principle that in the face of discordant clinical and radiological evidence. We present the case of a full-term female neonate, born at 39 weeks of gestation, who developed symptoms of green vomiting and delayed bowel movements on her second day of life. An initial colon in loop contrast study at eight days of age was suggestive of short-segment Hirschsprung disease, showing a narrowed rectal lumen and a transition zone in the rectosigmoid region. However, due to persistent signs of distal bowel obstruction, surgical exploration was performed on the ninth day of life. Intraoperatively, the diagnosis was revised to Type 3A ileal atresia located 20 cm from the ileocecal junction, with significant adhesions. The management involved adhesiolysis, resection of the atretic ileal segment, and a primary ileo-ascending anastomosis. The postoperative course was complicated by hypovolemic shock and suspected sepsis neonatorum, which were managed successfully with intensive care support, including intravenous antibiotics and parenteral nutrition. The patient showed significant improvement by the fifth postoperative day and was discharged with normal gastrointestinal function. In conclusion, this case underscores a critical diagnostic pitfall where the 'microcolon of disuse' in distal ileal atresia radiologically mimicked the transition zone of Hirschsprung disease. It highlights that while contrast studies are invaluable, a high index of clinical suspicion and readiness for surgical exploration are essential for accurate diagnosis and timely intervention in complex cases of neonatal bowel obstruction.

Temporal Dynamics of Postoperative Enterocolitis in Hirschsprung Disease: A Comparative Analysis of Earlier Onset After TAERPT versus the Duhamel Procedure Anisa Ika Pratiwi; Nunik Agustriani; Suwardi; Ida Bagus Budhi Surya Adnyana; Henky Agung Nugroho
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1478

Background: Hirschsprung-associated enterocolitis (HAEC) remains the most formidable cause of morbidity in surgically corrected Hirschsprung disease (HD). While the transanal endorectal pull-through (TAERPT) and the Duhamel procedure are standard treatments, a critical knowledge gap exists regarding the timing of postoperative HAEC onset associated with each technique. This study aimed to investigate and compare the temporal dynamics of HAEC presentation following these distinct surgical reconstructions. Methods: This single-center, retrospective cohort study reviewed 64 HD patients who underwent either TAERPT (n=32) or a modified Duhamel procedure (n=32) between January 2022 and January 2023 at a tertiary referral hospital. The primary outcome was the incidence of severe HAEC (HAEC score ≥10). The principal secondary outcome was the time to onset of the first episode of mild-to-moderate HAEC (score <10). Due to the non-normal distribution of onset data, the Mann-Whitney U test was used for statistical comparison. Results: Baseline demographic and clinical characteristics were comparable between the two cohorts. The incidence of severe HAEC was 0% in both the TAERPT and Duhamel groups. All recorded complications were mild-to-moderate and managed non-surgically. A statistically significant and clinically profound difference in the timing of these complications was observed. The median onset of HAEC in the TAERPT group was 6.0 months (Interquartile Range [IQR], 3.0-6.0), which was significantly earlier than the median onset of 8.5 months (IQR, 3.0-24.0) in the Duhamel group (p < 0.001). The mean onset times were 5.50 ± 1.90 months and 16.09 ± 16.33 months, respectively. Conclusion: Although both TAERPT and the Duhamel procedure demonstrated excellent safety profiles regarding severe HAEC, their associated temporal patterns of mild-to-moderate enterocolitis are markedly different. The significantly earlier onset of complications following TAERPT suggests that postoperative surveillance strategies should be procedure-specific, with intensified clinical vigilance during the first postoperative year for TAERPT patients.

Temporal Dynamics of Postoperative Enterocolitis in Hirschsprung Disease: A Comparative Analysis of Earlier Onset After TAERPT versus the Duhamel Procedure Anisa Ika Pratiwi; Nunik Agustriani; Suwardi; Ida Bagus Budhi Surya Adnyana; Henky Agung Nugroho
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1478

Background: Hirschsprung-associated enterocolitis (HAEC) remains the most formidable cause of morbidity in surgically corrected Hirschsprung disease (HD). While the transanal endorectal pull-through (TAERPT) and the Duhamel procedure are standard treatments, a critical knowledge gap exists regarding the timing of postoperative HAEC onset associated with each technique. This study aimed to investigate and compare the temporal dynamics of HAEC presentation following these distinct surgical reconstructions. Methods: This single-center, retrospective cohort study reviewed 64 HD patients who underwent either TAERPT (n=32) or a modified Duhamel procedure (n=32) between January 2022 and January 2023 at a tertiary referral hospital. The primary outcome was the incidence of severe HAEC (HAEC score ≥10). The principal secondary outcome was the time to onset of the first episode of mild-to-moderate HAEC (score <10). Due to the non-normal distribution of onset data, the Mann-Whitney U test was used for statistical comparison. Results: Baseline demographic and clinical characteristics were comparable between the two cohorts. The incidence of severe HAEC was 0% in both the TAERPT and Duhamel groups. All recorded complications were mild-to-moderate and managed non-surgically. A statistically significant and clinically profound difference in the timing of these complications was observed. The median onset of HAEC in the TAERPT group was 6.0 months (Interquartile Range [IQR], 3.0-6.0), which was significantly earlier than the median onset of 8.5 months (IQR, 3.0-24.0) in the Duhamel group (p < 0.001). The mean onset times were 5.50 ± 1.90 months and 16.09 ± 16.33 months, respectively. Conclusion: Although both TAERPT and the Duhamel procedure demonstrated excellent safety profiles regarding severe HAEC, their associated temporal patterns of mild-to-moderate enterocolitis are markedly different. The significantly earlier onset of complications following TAERPT suggests that postoperative surveillance strategies should be procedure-specific, with intensified clinical vigilance during the first postoperative year for TAERPT patients.

Penatalaksanaan Hematotoraks Sedang Et Causa Trauma Tumpul Diana Mayasari; Anisa Ika Pratiwi
Jurnal Agromedicine Unila: Jurnal Kesehatan dan Agromedicine Vol. 4 No. 1 (2017): Jurnal Agromedicine
Publisher : Fakultas Kedokteran Universitas Lampung

Show Abstract | Download Original | Original Source | Check in Google Scholar

Hematotoraks adalah adanya darah dalam rongga pleura dan dapat disebabkan karena trauma tumpul atau tajam, juga mungkin merupakan komplikasi dari beberapa penyakit. Hematotoraks dapat bersifat simptomatik namun dapat juga asimptomatik. Tujuan utama tatalaksana dari hematotoraks adalah untuk menstabilkan hemodinamik pasien, menghentikan perdarahan dan mengeluarkan darah serta udara dari rongga pleura. Seorang pasien remaja laki-laki berusia 17 tahun mengalami trauma tumpul dibagian dada sebelah kiri yang dialaminya dalam sebuah kecelakaan. Pada pemeriksaan fisik didapatkan kesadaran Somnolen, GCS 9 (E3V3M3), tanda vital tekanan darah 130/60 mmHg, nadi 100x/menit, kuat reguler, respirasi 28x/menit, pernafasan dangkal, suhu 35,8 0C, SPO2 82%, pupil isokor (3mm), reflek pupil langsung dan tidak langsung mata kanan dan kiri (+), pada leher terdapat jejas bagian kiri, pada dinding dada didapati hasil Inspeksi pergerakan dada asimetris ( gerakan dada kiri tertinggal), retraksi dinding dada bagian bawah kanan dan kiri (+), pada regio anterior toraks sinistra diatas processus xypoideus terdapat jejas ukuran ± 1x5 cm, ictus cordis tidak terlihat dan tidak teraba, perkusi redup pada thoraks sinistra, suara nafas kiri menjauh, vesikular (-/+), ronki basah (+/-) dan pada pemeriksaan rontgen thoraks AP didapati gambaran semi opaq dan sudut costo frenikus tumpul pada thoraks sinistra yang mengarah kepada hematotorak. Langkah pertama yang di lakukan pada pasien ini adalah stabilisasi hemodinamik dengan melakukan resusitasi lalu di lakukan tindakan pemasangan Water Sealed Drainage untuk mengeluarkan darah yang terjebak pada rongga pleura pasien dengan total perdarahan yang didapat sebanyak 750 cc. Kata kunci: hematotoraks, trauma tumpul thoraks, water sealed drainage

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