Hirschsprung-associated Enterocolitis
Everything in the library about Hirschsprung-associated enterocolitis — built automatically from the recorded discussions that name it
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
Acute Management
1 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
Medical Management
1 item
Update Course Rewind: Botox in Hirschsprung Disease 2023
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Our 11th Annual Update Course in Pediatric Surgery was held past August. In this video series, we'll recap the sessions and share the main highlights with you. Today, we'll talk about "Botox in Hirschsprung Disease". Joining the discussion
video5:55 · Feb 2024
Case-Based Learning
2 items
Colorectal Quiz Episode 19: Hirschsprung Disease - The Obstructed Patient Part 1
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We've discussed Hirschsprung Disease at length before but today we visit a complicated topic that many deal with, obstruction. Dr. Levitt and Dr. Frischer speak with Dr. Rentea from Children's Mercy at Kansas City about the obstructed patie
podcast24:11 · Aug 2021
The Colorectal Quiz Episode 20: Hirschsprung Disease Obstruction Part 2
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We've discussed Hirschsprung Disease at length before but today we visit a complicated topic that many deal with, obstruction. Dr. Levitt and Dr. Frischer speak with Dr. Rentea from Children's Mercy at Kansas City about the obstructed patie
podcast21:29 · Sep 2021
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Update Course Rewind: Botox in Hirschsprung Disease 2023
Every baby with Hirschsprung disease has a poorly functioning sphincter by nature of the disease
clinicalCaitlin Smith1:14 ↗
In order to maintain continence, you want to preserve the dentate line, and you have to leave a tiny bit of aganglionic internal sphincter
clinicalCaitlin Smith2:17 ↗
Babies outgrow enterocolitis because their external sphincter is able to overcome their internal sphincter, and that takes time for their body to mature
opinionCaitlin Smith2:23 ↗
The Hirschsprung physiology sets up the colon to act like a pond with poor emptying and motility issues, allowing bacteria to overgrow if the colon is not cleared diligently
clinicalSteven Lee or Doctor Julia Grabowski2:37 ↗
There is a significantly higher rate of enterocolitis in Hirschsprung disease after pull-through when you take out the entire colon compared to babies with shorter segment disease
epidemiologicalCaitlin Smith3:06 ↗
There is a much higher rate of enterocolitis in children with trisomy 21
epidemiologicalCaitlin Smith3:21 ↗
You can still get enterocolitis even if you're doing rectal irrigations at home; there are times when it's just not enough to empty that colon
clinicalI'm Goddy3:25 ↗
There is discussion of whether when you make the diagnosis of total colon Hirschsprung, you should do the colectomy at that time because of the risk of enterocolitis
opinionCaitlin Smith3:35 ↗
There is so much phenotypic variance in Hirschsprung disease that studying the use of Botox in post-pull-through enterocolitis yields imperfect data
opinionCaitlin Smith3:49 ↗
Prophylactic Botox has not been shown to decrease the risk of enterocolitis
clinicalCaitlin Smith4:14 ↗
Botox has been shown to decrease the length of stay in patients who have been admitted for enterocolitis
clinicalCaitlin Smith4:14 ↗
Botox has been shown to potentially decrease hospitalizations in patients who present with recurrent episodes of obstruction or enterocolitis
clinicalCaitlin Smith4:26 ↗
Maybe not everyone needs Botox at the time of pull-through, but there is a subset of patients who have predisposition to enterocolitis for whom Botox as part of treatment strategy would be beneficial
opinionCaitlin Smith4:34 ↗
Botox is often administered as 100 units in 1 mL of saline
clinicalCaitlin Smith1:45 ↗
Botox injection technique typically involves 3-4 injections in the dentate line
clinicalCaitlin Smith1:48 ↗
People are doing any amount of Botox in any aliquots in any number of locations (technique varies widely in the literature)
clinicalCaitlin Smith1:33 ↗
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 ↗
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