Collection
Colorectal & Anorectal Surgery
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Social Impact & Access3 items
Impact of Reducing Time Lived With Colostomies on Social Stigma Affecting Children With Anorectal Malformations in Southwestern Uganda
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Background: The social stigma of families of children living with colostomies due to anorectal malformation (ARM) is significant in low-income countries (LICs). Improved access to pediatric surgery has resulted in more 1-stage ARM procedure
article · Nov 2026
Delays in Care for Children With Low Anorectal Malformations in Southwestern Uganda
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Introduction: Disparities in anorectal malformation (ARM) outcomes between high- and low-income countries may be due to delayed diagnosis in the latter setting. The Three Delays model, comprising delays in seeking, accessing, and receiving
article · Nov 2026
Methods families use to raise funds for anorectal malformation treatment at a single public referral hospital in Southwestern Uganda.
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In Uganda, only two public hospitals provide pediatric surgery services. With less than 10 pediatric surgeons serving approximately 20 million children in Uganda, most patients with anorectal malformations (ARMs) must make several trips to
article · Nov 2026
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 — Meera Kotagal, Suspected Hirschsprung's-associated enterocolitis (HAEC) Treatment Guideline... · 2:00
Global Health1 item
Hirschsprung's disease in low- and middle-income countries.
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Hirschsprung's disease (HD) is one of the most common causes of pediatric bowel obstruction in low- and middle-income countries (LMICs). This paper describes the unique aspects of presentation, diagnosis, management and post-operative care
article · Nov 2026
Enterocolitis Management1 item
Suspected Hirschsprung's-associated enterocolitis (HAEC) Treatment Guideline...
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Dr. Meera Kotagal discusses one approach to the management of known or suspected Hirschsprung's-associated enterocolitis. Here is more detail on the guideline in place at Cincinnati Children's Hospital [June 2019].
video · Jul 2019
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Suspected Hirschsprung's-associated enterocolitis (HAEC) Treatment Guideline...
Papers by Pastor et al and Gosain et al outline frameworks and clinical guidelines for management of enterocolitis
guidelineMeera Kotagal0:21 ↗
The guideline is most appropriate for patients with either known or suspected Hirschsprung's who present with GI symptoms and/or fever
guidelineMeera Kotagal0:21 ↗
GI symptoms in HAEC include abdominal distension, vomiting, no or minimal stool, foul smelling stool, or explosive diarrhea
clinicalMeera Kotagal0:21 ↗
Systemic signs of concern include fever, lethargy, age-adjusted tachycardia, tachypnea, hypotension, or oliguria
clinicalMeera Kotagal0:21 ↗
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
guidelineMeera Kotagal2:00 ↗
The exam should include a rectal exam
guidelineMeera Kotagal2:00 ↗
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
guidelineMeera Kotagal2:00 ↗
Irrigations should not be delayed for patients to get an x-ray
guidelineMeera Kotagal2:00 ↗
Irrigations should be repeated as frequently as every eight hours, but even every six or four hours as needed for sicker patients
guidelineMeera Kotagal2:00 ↗
Abdominal films should be obtained upon arrival and then repeated again after an irrigation to demonstrate adequate decompression
guidelineMeera Kotagal3:00 ↗
Abdominal films can be repeated throughout the course of the hospitalization as clinically necessary
guidelineMeera Kotagal3:00 ↗
Patients should be NPO and started on IV fluids to assist with resuscitation and hydration
guidelineMeera Kotagal3:00 ↗
Patients without systemic signs who are mostly clinically well can be maintained on either IV or oral flagyl during hospitalization
guidelineMeera Kotagal3:00 ↗
All patients who are vomiting should be on IV antibiotics
guidelineMeera Kotagal3:00 ↗
Patients with systemic signs who are sicker need broad spectrum antibiotics, specifically Zosyn and flagyl at Cincinnati Children's
guidelineMeera Kotagal3:00 ↗
All patients should get a CBC and a basic metabolic panel
guidelineMeera Kotagal4:00 ↗
A venous blood gas should be obtained for sicker patients to help evaluate resuscitation needs
guidelineMeera Kotagal4:00 ↗
Patients with systemic signs should be evaluated for potential admission to the ICU
guidelineMeera Kotagal4:00 ↗
After an admission for enterocolitis, patients are continued on metronidazole and irrigations for a few weeks and then slowly tapered
guidelineMeera Kotagal5:00 ↗
Underlying anatomic issues such as a stricture or a transition zone pull through must be addressed to prevent recurrent enterocolitis
clinicalMeera Kotagal5:00 ↗
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