From
StayCurrentMD
Suspected Hirschsprung's-associated enterocolitis (HAEC) Treatment Guideline...
With Dr. Meera Kotagal · hosted by Dr. Todd Ponsky
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Papers by Pastor et al and Gosain et al outline frameworks and clinical guidelines for management of enterocolitis
The guideline is most appropriate for patients with either known or suspected Hirschsprung's who present with GI symptoms and/or fever
GI symptoms in HAEC include abdominal distension, vomiting, no or minimal stool, foul smelling stool, or explosive diarrhea
Systemic signs of concern include fever, lethargy, age-adjusted tachycardia, tachypnea, hypotension, or oliguria
Patients should be seen and evaluated as soon as possible, ideally within one hour by someone with clinical expertise such as a surgical fellow or attending
The exam should include a rectal exam
If the patient is less than four weeks out from surgery, fellows should discuss the rectal exam with an attending surgeon prior to performing it
Irrigations should not be delayed for patients to get an x-ray
Irrigations should be repeated as frequently as every eight hours, but even every six or four hours as needed for sicker patients
Abdominal films should be obtained upon arrival and then repeated again after an irrigation to demonstrate adequate decompression
Abdominal films can be repeated throughout the course of the hospitalization as clinically necessary
Patients should be NPO and started on IV fluids to assist with resuscitation and hydration
Patients without systemic signs who are mostly clinically well can be maintained on either IV or oral flagyl during hospitalization
All patients who are vomiting should be on IV antibiotics
Patients with systemic signs who are sicker need broad spectrum antibiotics, specifically Zosyn and flagyl at Cincinnati Children's
All patients should get a CBC and a basic metabolic panel
A venous blood gas should be obtained for sicker patients to help evaluate resuscitation needs
Patients with systemic signs should be evaluated for potential admission to the ICU
After an admission for enterocolitis, patients are continued on metronidazole and irrigations for a few weeks and then slowly tapered
Underlying anatomic issues such as a stricture or a transition zone pull through must be addressed to prevent recurrent enterocolitis