Eosinophilic colitis in children after surgery for Hirschsprung disease

Introduction: eosinophilic colitis tends to appear with signs of enterocolitis, although cases have been described after episodes of subacute intestinal obstruction. We present our experience in children di­agnosed with eosinophilic colitis who had been previously operated for Hirschsprung disease.

Results: 7 out of 44 patients who underwent Hirschsprung disease were diagnosed with eosinophilic colitis. Median age of surgery for Hirschsprung disease was 3 months and the median age of diagnosis of eosinophilic colitis 21 months. Six cases debuted with diarrhea with blood. Six of seven children had enteritis prior to diagnosis of eosinophilic colitis and one of seven rectal bleeding. The infectious screening was negative in all cases. The diagnosis was performed by biopsy in all cases, compatible with eosinophilic colitis. Treatment: one patient did not require treatment, three children needed elemental formula and two patients systemic steroids (one of them finally required surgery). In all treated children the clinical picture was resolved, except in one case in which, given the persistence and impact of symptoms, required parenteral nutri­tion and finally colonic resection with ileostomy.

Conclusions: In our series, we found some association between Hirschsprung disease and eosinophilic colitis. In all cases it was found a certain temporal relationship between the two diseases, always eo­sinophilic colitis after surgery for Hirschsprung disease. The exclusion of cow’s milk proteins and the use of anti-inflammatory drugs have been effective in most cases.