Guillaume Alexander W D, Miller Andrew C, Nguyen Michael C
From the Department of Emergency Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, Allentown, PA.
Pediatr Emerg Care. 2019 Jul;35(7):e131-e132. doi: 10.1097/PEC.0000000000001108.
Hirschsprung disease is a congenital abnormality that can be surgically corrected. However, Hirschsprung-associated enterocolitis can be a life-threatening sequela. Very little has been published in the emergency medicine literature about the risk of enterocolitis and shock in patients with a history of Hirschsprung disease. We describe the case of a 6-month-old male infant with a history of multiple surgeries for Hirschsprung disease who presented to the emergency department with a seemingly benign viral gastrointestinal illness. His stable condition led him to be discharged. However, 4 days later, he returned to the emergency department with severe diarrhea and was subsequently admitted to the pediatric intensive care unit for the management of enterocolitis and shock. With this case report, we aim to raise emergency physicians' awareness of the serious and possibly fatal complications of Hirschsprung disease. We argue that this single element of a patient's medical history can alter the management of seemingly simple viral gastrointestinal illnesses; rather than be discharged, such a patient requires surgical consultation and possibly admission for close monitoring and treatment.
先天性巨结肠是一种可通过手术矫正的先天性异常疾病。然而，先天性巨结肠相关的小肠结肠炎可能是一种危及生命的后遗症。急诊医学文献中关于有先天性巨结肠病史患者发生小肠结肠炎和休克风险的报道极少。我们描述了一名6个月大的男婴病例，该男婴有多次先天性巨结肠手术史，因看似良性的病毒性胃肠道疾病就诊于急诊科。他病情稳定后出院。然而，4天后，他因严重腹泻再次返回急诊科，随后因小肠结肠炎和休克被收入儿科重症监护病房进行治疗。通过本病例报告，我们旨在提高急诊医生对先天性巨结肠严重且可能致命并发症的认识。我们认为，患者病史中的这一单一因素可能会改变对看似简单的病毒性胃肠道疾病的处理方式；这类患者不应出院，而需要外科会诊，可能还需要住院进行密切监测和治疗。
