Enterocolitis in Patients Who Been Surgically Treated for Hirschsprung's Disease
Following surgical treatment for Hirschsprung's disease, a birth defect in which the large intestine is lacking certain nerve cells and unable to move stool through, some patients may suffer from enterocolitis. This is an inflammation of both the large and small intestines.
Most of these patients who develop enterocolitis can be treated by irrigating the colon three times per day and taking oral metronidazole (Flagyl). If monthly re-evaluations show that the patient is improving, colonic irrigations are reduced to twice per day after one month, to once per day the following month, and eventually the irrigations and metronidazole are stopped altogether.
In rare instances, patients become so sick and resistant to medical treatment that the colostomy, an operation to create an artificial anus (stoma) to allow stool to leave the body, has to be redone.
Causes of Enterocolitis Not Fully Understood
We have no doubt that the development of enterocolitis depends at least in part on mechanical factors. We base this assertion on our observations of patients with colostomies and bowels that are functioning very well until the colostomy is connected to the anal canal. This creates a "high pressure" system, with the stool collecting in the lower part of the bowel, rather than exiting through the stoma. Patients then decompensate and develop enterocolitis.
This mechanical explanation is a bit simplistic. Additional factors involving immune reactions and other body systems may also play a role. As we learn more about the art and science of medicine, we realize that the human body contains complex mechanisms still not fully understood. A better understanding will come from ongoing basic science research to find out the real nature of Hirschsprung's disease.
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