Suspected Hirschsprung's-Associated Entercolitis (HAEC) Treatment Guideline

Treatment Principles for Suspected HAEC1). A surgical fellow or attending should personally see and evaluate all patients with suspected HAEC at the earliest possible opportunity (within 1 hour) and document exam and treatment plan. 2). A rectal exam should be performed as part of initial exam. If patient is <4 weeks from surgery, rectal exam or dilations should be discussed with the Attending Surgeon prior to performing exam. 3). Rectal irrigations should be initiated at earliest opportunity (within 1 hour) of arrival. Do not delay irrigations to wait for initial abdominal x-ray. Rectal irrigations should be performed by the person most versed in the process; A4S nurses are available to provide support and assistance. Irrigations should be Q8H at minimum (consider more frequent –Q6H or PRN –if severe enterocolitis). 4). Abdominal x-ray should be obtained on arrival and repeated after the initial irrigation and thereafter as needed to demonstrate adequate decompression. 5). Patient should be NPO and started on IVF . If significant abdominal distention, consider replogle. 6). Antibiotics: Any vomiting patients should be on IV antibiotics. 7). Laboratory tests that should be considered include: CBC, renal panel, and a venous blood gas (for any patient with systemic signs). 8). Disposition:•Patients withoutsystemic signs**: Admit to the surgical floor. •Patient withsystemic signs**: Should be evaluated for potential ICU admission. 9). All HAEC patients on the surgical floor should have vitalswith blood pressure measurement every 4 hours. Suspected Hirschsprung’s Associated Enterocolitis (HAEC) Treatment Guidelines Scenario: Patient with known/suspected Hirschsprung’s Disease (HD) presents to the ED with GI complaints* and/or fever . v2 Updated 4/2019 Outpatient:PO metronidazole is sufficient for low suspicion or mild cases Inpatient: WITHsystemic signs**WITHOUT systemic signs** IV broad-spectrum antibiotics, including metronidazole PO or IV metronidazole (low suspicion or mild cases may be managed with PO) *GI complaints may include:Abdominal distention, vomiting, no/minimal stooling, foul-smelling stool, and/or explosive diarrhea Rectal Irrigation Supplies:•Silicone foleycatheter (16 frfor children ≤1 year; 24 frfor children >1 year)•60 cc catheter tip syringe•Lubricant (water soluble)•Saline solution•2 non-sterile basins (e.g. emesis basin)Rectal Irrigation Orderset:Use “Hirschsprung Disease Rectal Irrigation” ordersetto order subsequent irrigations. Rectal Irrigation Video:https://cchmcstream.cchmc.org/MediasiteEX/Play/545154a603a844e8988ef74cd5b4c1c11d **Systemic signs include:Fever, lethargy, age-adjusted tachycardia, hypotension, tachypnea, oliguria