# Colorectal & Anorectal Surgery — GCMD Library living collection Updated: n/a · 5 episodes · 20 cited statements ## Episodes ### Anorectal Malformations - [Impact of Reducing Time Lived With Colostomies on Social Stigma Affecting Children With Anorectal Malformations in Southwestern Uganda](https://library.globalcastmd.com/article/impact-of-reducing-time-lived-with-colostomies-on-social-stigma-affecting-childr-16556) — article · [machine version](https://library.globalcastmd.com/article/impact-of-reducing-time-lived-with-colostomies-on-social-stigma-affecting-childr-16556.md) - [Delays in Care for Children With Low Anorectal Malformations in Southwestern Uganda](https://library.globalcastmd.com/article/delays-in-care-for-children-with-low-anorectal-malformations-in-southwestern-uga-16589) — article · [machine version](https://library.globalcastmd.com/article/delays-in-care-for-children-with-low-anorectal-malformations-in-southwestern-uga-16589.md) - [Methods families use to raise funds for anorectal malformation treatment at a single public referral hospital in Southwestern Uganda.](https://library.globalcastmd.com/article/methods-families-use-to-raise-funds-for-anorectal-malformation-treatment-at-a-si-16563) — article · [machine version](https://library.globalcastmd.com/article/methods-families-use-to-raise-funds-for-anorectal-malformation-treatment-at-a-si-16563.md) ### Hirschsprung Disease - [Hirschsprung's disease in low- and middle-income countries.](https://library.globalcastmd.com/article/hirschsprung-s-disease-in-low-and-middle-income-countries-16581) — article · [machine version](https://library.globalcastmd.com/article/hirschsprung-s-disease-in-low-and-middle-income-countries-16581.md) - [Suspected Hirschsprung's-associated enterocolitis (HAEC) Treatment Guideline...](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540) — video · [machine version](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540.md) ## Chapters - [0:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=0) Introduction (Ep 5) - [0:21](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=21) Background and Patient Population (Ep 5) - [2:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=120) Eight Key Steps of the Guideline (Ep 5) - [5:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=300) Post-Admission Management and Summary (Ep 5) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - Papers by Pastor et al and Gosain et al outline frameworks and clinical guidelines for management of enterocolitis — Meera Kotagal (guideline) [Ep 5 · 0:21](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=21) - The guideline is most appropriate for patients with either known or suspected Hirschsprung's who present with GI symptoms and/or fever — Meera Kotagal (guideline) [Ep 5 · 0:21](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=21) - GI symptoms in HAEC include abdominal distension, vomiting, no or minimal stool, foul smelling stool, or explosive diarrhea — Meera Kotagal (clinical) [Ep 5 · 0:21](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=21) - Systemic signs of concern include fever, lethargy, age-adjusted tachycardia, tachypnea, hypotension, or oliguria — Meera Kotagal (clinical) [Ep 5 · 0:21](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=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 — Meera Kotagal (guideline) [Ep 5 · 2:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=120) - The exam should include a rectal exam — Meera Kotagal (guideline) [Ep 5 · 2:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=120) - 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 — Meera Kotagal (guideline) [Ep 5 · 2:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=120) - Irrigations should not be delayed for patients to get an x-ray — Meera Kotagal (guideline) [Ep 5 · 2:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=120) - Irrigations should be repeated as frequently as every eight hours, but even every six or four hours as needed for sicker patients — Meera Kotagal (guideline) [Ep 5 · 2:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=120) - Abdominal films should be obtained upon arrival and then repeated again after an irrigation to demonstrate adequate decompression — Meera Kotagal (guideline) [Ep 5 · 3:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=180) - Abdominal films can be repeated throughout the course of the hospitalization as clinically necessary — Meera Kotagal (guideline) [Ep 5 · 3:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=180) - Patients should be NPO and started on IV fluids to assist with resuscitation and hydration — Meera Kotagal (guideline) [Ep 5 · 3:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=180) - Patients without systemic signs who are mostly clinically well can be maintained on either IV or oral flagyl during hospitalization — Meera Kotagal (guideline) [Ep 5 · 3:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=180) - All patients who are vomiting should be on IV antibiotics — Meera Kotagal (guideline) [Ep 5 · 3:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=180) - Patients with systemic signs who are sicker need broad spectrum antibiotics, specifically Zosyn and flagyl at Cincinnati Children's — Meera Kotagal (guideline) [Ep 5 · 3:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=180) - All patients should get a CBC and a basic metabolic panel — Meera Kotagal (guideline) [Ep 5 · 4:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=240) - A venous blood gas should be obtained for sicker patients to help evaluate resuscitation needs — Meera Kotagal (guideline) [Ep 5 · 4:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=240) - Patients with systemic signs should be evaluated for potential admission to the ICU — Meera Kotagal (guideline) [Ep 5 · 4:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=240) - After an admission for enterocolitis, patients are continued on metronidazole and irrigations for a few weeks and then slowly tapered — Meera Kotagal (guideline) [Ep 5 · 5:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=300) - Underlying anatomic issues such as a stricture or a transition zone pull through must be addressed to prevent recurrent enterocolitis — Meera Kotagal (clinical) [Ep 5 · 5:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=300) --- Educational content from recorded physician discussions — not medical advice. 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