# Suspected Hirschsprung's-associated enterocolitis (HAEC) Treatment Guideline... — GCMD Library

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].

Type: video · posted 2019-07-20 Canonical: https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540 ## Chapters - [0:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=0) Introduction - [0:21](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=21) Background and Patient Population - [2:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=120) Eight Key Steps of the Guideline - [5:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=300) Post-Admission Management and Summary ## Statements - "Papers by Pastor et al and Gosain et al outline frameworks and clinical guidelines for management of enterocolitis" — Meera Kotagal (guideline) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [5:00](https://library.globalcastmd.com/watch/suspected-hirschsprung-s-associated-enterocolitis-treatment-guideline-1540?t=300) --- Not medical advice · citation policy: https://library.globalcastmd.com/ai