{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:46:20Z","timestamp":1790354780269,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2024,7,1]],"date-time":"2024-07-01T00:00:00Z","timestamp":1719792000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Paediatrica"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Extended total colonic aganglionosis (ETCA) represents uncommon forms of Hirschsprung disease (HD), with aganglionosis extending into the proximal small bowel. ETCA management is challenging and associated with poor outcomes and high mortality. This study compares management and outcomes of ETCA to more common HD forms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort of HD patients (2012\u20132023) from two institutions. Three HD forms were compared: short\u2010segment HD (SSHD, <jats:italic>n<\/jats:italic>\u2009=\u200919), long\u2010segment HD or total colonic aganglionosis (LS\/TCA, <jats:italic>n<\/jats:italic>\u2009=\u20099) and ETCA (<jats:italic>n<\/jats:italic>\u2009=\u20097).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Normally innervated segments in ETCA patients ranged 0\u201370\u2009cm. Median times to first surgery were; ETCA\u2009=\u20093\u2009days versus TCA\u2009=\u200921\u2009days (<jats:italic>p<\/jats:italic>\u2009=\u20090.017) and SSHD\u2009=\u200995\u2009days (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), respectively. Median number of surgeries were; ETCA\u2009=\u20094, versus TCA\u2009=\u20092 (<jats:italic>p<\/jats:italic>\u2009=\u20090.17) and SSHD\u2009=\u20091 (<jats:italic>p<\/jats:italic>\u2009=\u20090.002), respectively. All the patients underwent a definitive pull\u2010through procedure, except four ETCA patients with a permanent jejunostomy and residual aganglionic segment of 57\u2013130\u2009cm. ETCA patients had 92% lower odds of enterocolitis (14%) compared to TCA patients (67%, <jats:italic>p<\/jats:italic>\u2009=\u20090.054), and comparable odds to SSHD patients (16%, <jats:italic>p<\/jats:italic>\u2009=\u20090.92). ETCA mortality was 14%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Extended total colonic aganglionosis patients require earlier and multiple interventions. Leaving an aganglionic segment may be advantageous, without increasing risk for enterocolitis. Tailored surgical treatment and rehabilitation programmes may prevent mortality and need for transplantation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apa.17341","type":"journal-article","created":{"date-parts":[[2024,7,1]],"date-time":"2024-07-01T13:45:04Z","timestamp":1719841504000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Extended total colonic aganglionosis and total intestinal aganglionosis: Challenging enemies"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5192-3185","authenticated-orcid":false,"given":"Audelia","family":"Eshel\u00a0Fuhrer","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Dana\u2010Dwek Children's Hospital, Affiliated to the Faculty of Medicine Tel Aviv University  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Govorukhina","sequence":"additional","affiliation":[{"name":"Republican Scientific and Practical Center for Pediatric Surgery  Minsk Belarus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gal","family":"Becker","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Dana\u2010Dwek Children's Hospital, Affiliated to the Faculty of Medicine Tel Aviv University  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoav","family":"Ben\u2010Shahar","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Dana\u2010Dwek Children's Hospital, Affiliated to the Faculty of Medicine Tel Aviv University  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadar","family":"Moran\u2010Lev","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology Unit, Dana\u2010Dwek Children's Hospital, Affiliated to the Faculty of Medicine Tel Aviv University  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Sukhotnik","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Dana\u2010Dwek Children's Hospital, Affiliated to the Faculty of Medicine Tel Aviv University  Tel\u2010Aviv 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