Treatment of Hirschsprung's Disease in Mild HAEC with Diarrhoea and Normal Inflammatory Markers
Hirschsprung's-associated enterocolitis (HAEC) is a recognised complication of Hirschsprung's disease. When the presentation is mild — explosive, foul-smelling diarrhoea without fluid or electrolyte balance disturbance and with normal inflammatory markers — the clinical approach differs from more severe or hospitalised presentations.
Clinical scenario: Mild Hirschsprung's-associated enterocolitis presenting with explosive, foul-smelling diarrhoea; no fluid or electrolyte balance disturbance; normal inflammatory markers. HAEC should be clinically suspected in the presence of diarrhoea with explosive, foul-smelling stool, and/or > 4 points from the Pastor et al. HAEC score items.
Approach: For carefully selected, clinically well patients meeting this mild presentation, an outpatient approach with close home observation may be appropriate — though the full structured regimen specifies the precise interventions, decision thresholds, and the conditions under which prompt admission becomes necessary.
References
DOI: 10.1186/s13023-020-01362-3
- HAEC should be clinically suspected in the presence of diarrhoea with explosive, foul-smelling stool, and/or > 4 points from the Pastor et al. HAEC score items (Table 8).
- In mild symptoms with no fluid or electrolyte balance disturbance and normal inflammatory markers, outpatient treatment with oral hydration +/− oral metronidazole and rectal irrigations may be appropriate, but prompt admission is indicated if symptoms do not improve.
- Management with rectal irrigations and close observation at home with a low threshold for oral metronidazole may be an option for carefully selected, clinically well patients with mild symptoms and normal fluid balance.
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