Hirschsprung’s enterocolitis

What is Hirschsprung’s enterocolitis?

Enterocolitis is the most serious complication of Hirschsprung’s disease. It can be life threatening. Enterocolitis is an inflammation or infection of the gut. The large intestine cannot push poo through as it should which can cause a partial or full blockage.

Who gets it?

All children with Hirschsprung’s disease are at risk of enterocolitis. It can happen before or after surgery for Hirschsprung’s disease. Some children are first diagnosed with Hirschsprung’s disease when they show symptoms of enterocolitis. After surgery for Hirschsprung’s disease the greatest risk of getting enterocolitis is in the first year after surgery. However some children can present with enterocolitis several years after their operation.

What causes it?

It is not known why some children with Hirschsprung’s disease get enterocolitis and others are never affected. A few things may cause it to happen:

• the slow passing of poo with bacteria growing too much in the bowel
• a decrease in the bowel wall’s defence mechanism
• a particular bacteria taking hold (often Clostridium difficile)

What are the symptoms?

Children have various symptoms with Hirschsprungs’s enterocolitis.The main symptoms are:

• diarrhoea
• abdominal distension
• fever
• colicky (cramping) abdominal pain
• lethargy
• bloodstained poo

Your child does not have to have all of these symptoms to have enterocolitis. If your child is unwell and has a change in their normal bowel habit you should get medical advice.

Why is it dangerous?

The main problem is that your child can become dehydrated very quickly. This is because lots of fluid gather in the inflamed gut. Children may die from enterocolitis if they are not treated soon enough. They are also unwell because of the infection.

What are the treatments?

The main treatment is to rehydrate your chid with intravenous fluids and to give antibiotics. However they may also need bowel washouts to empty the bowel. If enterocolitis is severe it sometimes has to be treated with a temporary colostomy or ileostomy where the bowel is brought out on to the tummy wall.

Where to get help

Unfortunately because Hirschsprung’s disease is quite rare not all doctors know about Hirschsprung’s enterocolitis. Suspected gastroenteritis (a tummy bug) in a child with Hirschsprung’s disease should be treated as enterocolitis. If you are at all concerned that your child has Hirschsprung’s enterocolitis then please get in touch with the paediatric surgical team at Sheffield Children’s hospital.