Hirschsprung-associated enterocolitis in children: An ERNICA animation for parents and families

This animation aims to provide you with more information about a problem called enterocolitis, which can be experienced by children with Hirschsprung's disease. Enterocolitis is an inflammation of the intestine that occurs when the body does not get rid of poop quick enough. A blockage forms in the large intestine, which causes it to swell. Bacteria grows and enters the blood vessels. In rare cases, a bowel perforation can occur, which is when a hole develops on the wall of the large intestine due to pressure. Signs and symptoms of enterocolitis may include smelly explosive poop, which may sometimes contain blood, a swollen and painful belly, nausea and or vomiting, and fever. An individual may also show signs of dehydration, such as a lack of activity and reduced urination. Up to 40-50% of children with Hirschsprung's disease experience enterocolitis, either before or after surgical correction. Enterocolitis is more common after surgical correction. For a small number of children, enterocolitis can be persistent and occur repeatedly throughout their life. There are various underlying causes of Hirschsprung associated enterocolitis, and it can be triggered by various different factors, such as a virus, bacterial infection, or intestinal dysbiosis. To treat symptoms of enterocolitis in children, it is very important to remove the blockage of poop in the large intestine. This is called irrigation, and it is done using a special tube called a rectal cannula. If enterocolitis becomes a repeated problem, your child's clinical team may teach you how to carry this out at home. Symptoms of dehydration can be treated with a drinkable rehydration solution or where necessary, fluid can be given to your child through a vein. Blood infections must be prevented using antibiotic medication. When symptoms have improved, it is important for your child's clinical team to investigate possible triggers and underlying causes of the enterocolitis. It may be caused by obstruction due to bowel dysfunction or by the anatomy of the remaining bowel after the pull-through operation. Also, children with Hirshsprung's disease often experience difficulties getting rid of poop because of tight sphincter muscles in the anus. There can also be behavioral and psychological causes. Possible treatment includes support with bowel management, internal Botox injections, and in some cases, surgery. Structured regular follow-up care by a team of different clinical specialists is essential for children with Hirschsprung's disease, ideally by a multidisciplinary team or MDT. Identifying any complications or difficulties early is very important. Even if your child has symptoms of enterocolitis after corrective surgery for Hirschprung's disease, these can improve as they grow older. Peer support can be accessed through patient and family support groups.