Appendicostomy for intraluminal antibiotic administration and extracorporeal membrane oxygenation support in severe...

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Critical Care Medicine

Background:

• Hirschsprung's disease requires surgical correction, typically an endorectal pull-through procedure.
• Postoperative complications can arise, necessitating advanced medical interventions.

Observation:

• A term male infant, post-laparoscopic-assisted endorectal pull-through for Hirschsprung's disease, developed severe Clostridium difficile enterocolitis.
• The patient presented with hemodynamic instability and peritonitis four weeks after discharge.

Findings:

• Bedside laparotomy confirmed intestinal viability and led to the creation of an appendicostomy for antegrade vancomycin colonic irrigations.
• The patient required venoarterial extracorporeal membrane oxygenation (ECMO) for over six days for physiological support.
• Successful transition to conventional support resulted in survival and hospital discharge without hemorrhagic complications.

Implications:

• This case highlights the critical management of severe Clostridium difficile enterocolitis in infants post-Hirschsprung's surgery.
• Antegrade vancomycin irrigation via appendicostomy and ECMO can be life-saving interventions in pediatric surgical critical care.
• The patient's current developmentally appropriate status indicates a favorable long-term outcome.