II. Pathophysiology
- Typically occurs after definitive Hirschsprung's pull-through repair (1 to 20 months post-operatively)
III. Risk Factors
IV. Symptoms
- Early
- Abdominal Distention
- Foul-smelling watery stools or Diarrhea
- Lethargy
- Failure to Thrive
- Late
- Emesis or Hematochezia
- Fever
- Sepsis
- High mortality rate
V. Imaging
- Abdominal XRay
- Dilated bowel loops with air-fluid levels
- Rectosigmoid cut-off sign
- Pneumotosis intestinalis
- Intestinal perforation findings may be present
VI. Management
- Acute stabilization
- Intravenous Fluids
- Nasogastric suction
- Broad spectrum IV antibiotics
- Rectal irrigation 3-4 times daily
- Normal Saline infused in Rectum via Rubber catheter
- Insert in steps
- Total infused: 10-15 cc/kg
- Wait for 10-15 cc to leak out of Rectum
- Then insert cathetr further
- Disposition
- Hospital observation for serial abdominal exams is typically recommended even in mild cases
