title: Appendicostomy for intraluminal antibiotic administration and extracorporeal membrane oxygenation support in severe Hirschsprung's enterocolitis.
abstract: A term male infant with Hirschsprung's disease underwent an uncomplicated laparoscopic-assisted endorectal pull-through procedure. Four weeks after discharge, the patient developed severe Clostridium difficile enterocolitis with hemodynamic instability and peritonitis. Bedside laparotomy confirmed intestinal viability and accommodated an appendicostomy for antegrade vancomycin colonic irrigations. The patient required venoarterial extracorporeal membrane oxygenation for physiological support for more than six days. Transition to conventional support was successful with survival and discharge from the hospital free from hemorrhagic complications. The patient is now developmentally appropriate for his age.
authors.affiliation: Division of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Phillips
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Erickson
authors.forename: William T
authors.initials: WT
authors.lastname: Adamson
authors.forename: Sean E
authors.initials: SE
authors.lastname: McLean
mesh_terms: D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001065:Appendix / Q000601:surgery*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D012809:Colon, Sigmoid / Q000601:surgery; D003125:Colostomy; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology / Q000628:therapy*; D015199:Extracorporeal Membrane Oxygenation; D005243:Feces / Q000382:microbiology; D006627:Hirschsprung Disease / Q000150:complications* / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D007507:Therapeutic Irrigation; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin