Colonic Irrigations for Enterocolitis in Children With Hirschsprung Disease

If your child has Hirschsprung disease, they can get an infection in the large intestine called enterocolitis that may make them very sick. The symptoms of enterocolitis are:

• Fever above 100.5° F (38° C)
• Swollen belly (distention)
• Not pooping (constipation)
• Throwing up (vomiting)
• Explosive diarrhea
• Foul smelling poop or gas

• A colonic irrigation is used to clear the bowels when there is a concern for enterocolitis. You inject small amounts of salt water (saline) into the hole where poop comes out (anus) through a large tube (catheter) to fill the colon with water (irrigate).
• It is different from an enema, which uses a large amount of saline with a stimulant, such as soap, to cause your child to poop.

• You should give your child a colonic irrigation first, following the steps on page 2, then call your doctor. While your child has symptoms of enterocolitis, you will need to irrigate 3 times a day or more often, if needed.
• If your child recently had surgery for Hirschsprung disease, do not give your child a colonic irrigation for at least 4 weeks after surgery. If it has been less than 4 weeks since your child’s surgery and they have symptoms of enterocolitis, please call your surgeon’s office for further instructions.
• You may need to take your child to Seattle Children’s Hospital Emergency 
• If you have questions after office hours, please call the hospital operator at 206-987-2000 and ask to speak with the General Surgeon on call.

• Normal salt water (saline)
• Bath towels or washcloths
• 2 small tubs or basins
• 60 mL (milliliter) catheter-tip syringe
• Water-soluble lubricant (Surgi-lube packets or KY Jelly)
• Silicone catheter, or red rubber catheter (The red rubber catheter contains latex. Do not use it if your child has a latex allergy. Silicone is OK.)
  
  • Size 16 French for a child less than 1 year
  • Size 24 French for a child over 1 year

1. Warm the normal saline bottle in a sink of warm water. Test the temperature on your wrist to make sure it’s not too hot.
2. Pour the saline into 1 small tub or basin.
3. Lubricate the tip of the catheter.
4. Lie your child on their back, with knees bent to their chest.
5. Gently insert the lubricated catheter into the hole where poop comes out (anus).
6. Pause, allow for poop or gas to run out into the empty tub or basin.
7. As you move the catheter further in, allow for any other pockets of gas or poop to empty. Push the catheter gently, so it follows the natural curve of the colon. Do not force it or push it in any further than the “y” of the catheter.
8. Draw up 20 mL of the warm saline into the syringe.
9. Attach the syringe to the catheter.
10. Inject the saline into the catheter.
11. Take the syringe off the end of the catheter and let the saline drain into the basin.
12. Repeat steps 8 to 11. Move the catheter in about 1 inch each time, before injecting the 20 mL of warm saline.
13. Every time, after you inject the saline, let it drain from the catheter into the basin.
14. If the amount draining out of the catheter is not the same or is more than the amount of saline that has been put in, move the catheter in and out while twisting it, to drain the pockets of saline, gas and poop.
15. If the catheter hasn’t drained well, attach the syringe to the catheter and pull back gently on the syringe. Do not pull on the syringe if you meet resistance! If you notice you are not getting out as much fluid as you put in, over the next couple of irrigations, do not put in more fluid.
16. Repeat this process until the fluid draining out of the catheter is clear.
17. Once the fluid draining out of the catheter is clear, take the catheter out of your child’s anus.
18. Wash the supplies with soap and water and let them dry. You can re-use these supplies.