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This guide is to help parents perform this procedure under the supervision of their nurse or physician.
Patients with Hirschsprung disease may suffer from an inflammatory process of the colon called “colitis”. Colitis could affect your child before or after corrective surgery due to an obstruction to the outflow in the rectum causing immobility of stool, bacterial overgrowth and inflammation of the colonic mucosa. Colitis produces hypomotility (slow transit) worsening the obstruction and secretory diarrhea. Sometimes colitis gives other symptoms such as failure to thrive and intermittent cramping and abdominal pain.
The treatment of colitis involves release of the obstruction with a rectal catheter and irrigations of the colon, antibiotics (metronidazole) and hydration.
Rectal irrigations are the best method to clean (wash out) the colon of stool and to prevent "stasis" of stool in the colon. Your child should be irrigated with normal saline solution beginning with 10-20 ml at a time for a total of 20ml/kg. If the saline is returned during the irrigation process, then this volume can be repeated.
The caliber of the Foley is based on child size; parents may purchase sizes between 16fr and 24fr based on anus size and integrity of the rectum. The lumen sizes of these catheters are larger to allow passing of thick stool through the catheter.
Repeat this process until the discarded fluid is clear.
Note: It is important to observe the volume between instillations of saline solution drained from the catheter into the basin; you should have the same amount of instilled solution plus stool in the basin. This process is very different than an enema, which introduces the fluid but does not allow it to passively come out.
Flagyl® given orally may be poorly tolerated by some children because of its metallic taste, therefore, utilized in the daily irrigation is very effective. The goal is to treat the bacterial overgrowth, most specifically, Clostridium difficile. The irrigation overcomes the stasis of the stool and allows for more frequent emptying of the colon.
30 mg/kg/day. Flagyl® intravenous solution is 500 mg in 100 ml. (1 ml = 5 mg)
Your child should be irrigated with normal saline solution. The quantity of solution that you have to use is based on your child's body weight and it is calculated as 20 ml of solution per each kilogram of body weight (20 ml per each 2.2 pounds); for example: if your child's weight is 10 kg (22 lbs.), you have to use 200 ml of saline solution giving 10-20 ml at a time until you have used the 200 ml. The rationale is to clean the colon of stool before instilling the Flagyl®.
To begin Flagyl® irrigations, proceed as follows:
Note: It is important to observe the volume between instillations of Flagyl® drained from the catheter into the basin; you should have the same amount of instilled Flagyl® plus stool in the basin.
Colonic Irrigation (PDF)
For more information about anorectal malformations or to request an appointment with the Colorectal Center for Children at Children’s Hospital of Pittsburgh of UPMC contact us at 412-692-7280 or by email at firstname.lastname@example.org.
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