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Enterocolitis
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Children with persistent problems after Hirschsprung surgery should not be expected to improve over time; anatomic causes can almost always be identified and corrected. — Marc Levitt, Hirschsprung Disease â PediaCast 287 · 24:03
Hirschsprung Disease â PediaCast 287
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Dr Marc Levitt joins Dr Mike in the PediaCast Studio for a comprehensive look at Hirschsprung Disease. We talk cause, symptoms, diagnosis, treatment, complicati
podcast38:55 · Jul 2026
Patients who develop the characteristic Duhamel pouch with fecal impaction in the rectum may never have had true Hirschsprung disease, as the aganglionic rectum should not distend. Hirschsprung Disease: Radiology Aspect · 36:33
Evaluation & Management Of Hirschsprung's Disease
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Dr. Steven Kraus discusses the radiology component of Hirschsprung's Disease. His presentation includes the predictors of Hirschsprung's Disease seen in a plain abdominal radiograph of a newborn, distal bowel obstruction identification, dia
video44:35 · Nov 2018
Radiology and Image Diagnosis of Hirschsprung Disease
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Panel discussion on various imaging techniques and radiologic findings for Hirschsprung Disease and the diagnostic pathway to and after surgery.
video44:35 · Nov 2018
Hirschsprung Disease: Radiology Aspect
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Dr. Steven Kraus from Cincinnati Children's Hospital presents on the radiological considerations in the diagnosis of Hirschsprung disease.
video43:27 · Jan 2019
Many pathologists are not measuring nerve caliber, and pediatric surgeons should demand that their pathologists do this to avoid doing a pull-through in the transition zone — Marc Levitt, Hirschsprung Disease Audience Q&A with Dr. Marc Levitt · 5:43
Hirschsprung Disease Audience Q&A with Dr. Marc Levitt
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Continuation of discussion on Hirschsprung disease with Dr. Marc Levitt with emphasis on the audience's questions .
podcast12:40 · Dec 2020
Before making a Hirschsprung diagnosis and embarking on a pull-through in a patient with anorectal malformation, think carefully—most likely it is not Hirschsprung; many patients suffer from constipation but very few have Hirschsprung. — Alberto Peña, Outcomes and Complications in Hirschsprung Disease · 1:34:10
Outcomes and Complications in Hirschsprung Disease
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Dr. Alberto Peña presents complications and cases of Hirschsprung's Disease. Dr. Peña discusses complications post pullthrough, non preventable enterocolitis, and constipation complications. Dr. Rintala presents on the outcomes of Hirschspr
video1:45:48 · Nov 2018
Hirschsprung Disease: Cases and Complications
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Dr. Alberto Peña presents complications and cases of Hirschsprung disease. Dr. Peña discusses complications after pull-through, non-preventable enterocolitis, and constipation complications. Dr. Rintala presents on the outcomes of Hirschspr
video1:43:35 · Jan 2019
Colorectal - Clinical Practice Updates
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This clip from the 2020 Pediatric Surgery Update Course features, Megan Durham, MD; Eunice Huang, MD; and Beth Rymeski, DO; presenting cases for review and recent studies.
Highlighted Topics Include:
- Post-op Hirschsprung home regimen
video52:31 · Sep 2020
Hirschsprung Disease Part II with Dr. Marc Levitt
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Continuation of discussion on Hirschsprung disease with Dr. Marc Levitt with emphasis on complex situations.
podcast44:38 · Dec 2020
Update Course Rewind: 2020 Colorectal Part 1
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Did you miss our annual Update Course? Don't worry, we are summarizing our favorite sessions from years past. In this episode, Dr. Megan Durham and Dr. Eunice Huang talk you through some perioperative considerations for patients with Hirsch
podcast12:25 · Mar 2021
The Colorectal Quiz Episode 22: Hirschsprung Disease - the Soiling Patient Part 1
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In the last few episodes of the Colorectal Quiz, we discussed obstructions in Hirschsprung disease. Now we're turning to another issue in Hirschsprung disease - the soiling patient. Along with Dr. Levitt and Dr. Frischer, we're joined by Dr
podcast19:45 · Nov 2021
Hirschsprung Disease Part 2
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Continuation of our previous podcast on Hirschsprung disease with Dr Marc Levitt that focuses on the evaluation and management of post-pull-through complication
podcast44:44 · Jul 2026
Cincinnati Children's study from 2020 to 2024 found decreased risk of enterocolitis within 31 days after pull-through procedure: 0% versus 30% — Lei Wen, Update Course Rewind 2025: Botox for Hirschsprung’s: Where, When, and Why · 0:55
The use of postoperative calibrations in Hirschsprung disease
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Federico Beati, Tommaso D'Angelo, Chiara Iacusso, Barbara Daniela Iacobelli, Federico Scorletti, Laura Valfré, Chiara Pellegrino, Pietro Bagolan, Andrea Conforti, Fabio Fusaro.
Purpose: Daily postoperative anal dilations after endorectal
video0:59 · Nov 2024
Update Course Rewind 2025: Botox for Hirschsprung’s: Where, When, and Why
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This video from GlobalCast MD, featuring Cincinnati Children's, recaps key insights from the 13th Annual Pediatric Surgery Update Course on the use of Botox in Hirschsprung's Disease. It discusses current practices, poll results among pedia
video1:55 · May 2026
Colorectal Quiz Ep. 50 -16th Annual European Pediatric Colorectal & Pelvic Reconstruction Conference
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In this special 50th episode of the Colorectal Quiz Podcast, Dr. Marc Levitt and an international panel review key takeaways from the 16th European Pediatric Colorectal Reconstruction Meeting in Stockholm, highlighting emerging ideas, evolv
video · Jul 2026
Contrast enema plus suction rectal biopsy is the standard initial workup for newborn distal bowel obstruction suspected to be Hirschsprung disease, not upper GI series. — Daniel von Allmen, Hirschprung's Disease - Daniel von Allmen · 7:00
Hirschprung's Disease - Daniel von Allmen
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Daniel von Allmen discusses various case presentations involving hirschprung's disease patients. Topics of discussion include upper GI imaging, contrast enema, ganglion cell biopsies, duhamel, isolated cecal perforation, primary transanal p
video38:50 · Nov 2018
Hirschsprung Disease Rapid Fire: Update Course 2015
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Dr. Jason Frischer of Cincinnati Children's Hospital Medical Center, presents on Hirschsprung disease. Dr. Frischer discusses Hirschsprung disease and its complications.
video12:14 · Jan 2019
Hirschsprung Disease: Update Course 2015
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Dr. Jason Frischer, pediatric surgeonat Cincinnati Children hospital, presents a few cases of Hirschsprung disease. Topics of discussion include for trans-anal dissection, laparoscopic biopsy, mobilization of the colon, open biopsy, and lev
video7:42 · Jan 2019
Hirschsprung Disease: Update Course 2013
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Daniel von Allmen discusses various case presentations involving Hirschprung disease patients. Topics of discussion include upper GI imaging, contrast enema, ganglion cell biopsies, Duhamel, isolated cecal perforation, primary trans-anal pu
video38:06 · Jan 2019
Hirschsprung Disease: Update Course 2013
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Dr. Daniel von Allmen discusses the evaluation and management of Hirschsprung disease. Topics include initial imaging options, rectal biopsy options, operative approaches, timing for definitive procedure, types of pull-through, and treatmen
video38:50 · Jan 2019
Colorectal Quiz Episode 3: Hirschsprung Disease
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In the third episode of the Colorectal Quiz series, Dr. Levitt and Dr. Frischer discuss the basics of the initial management and diagnosis of Hirschprung disease.2 view abdominal XRContrast enema
podcast20:10 · Feb 2021
Any patient with an absent RAIR must undergo a rectal biopsy for confirmation of the diagnosis. — Jason Frischer, Hirschsprung's Disease · 4:23
Hirschsprung Disease - Imperforate Anus - Rectal Prolapse: Update Course 2015
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Dr. Jason Frischer ofCincinnati Children's Hospital Medical Center,presents on Hirschsprung disease,Imperforate anus, and rectal prolapse. Dr. Frischer discussesHirschsprung disease and it'scomplications- obstructive systems or soiling issu
video25:37 · Nov 2018
Hirschsprung's Disease
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Dr. Rae Hanke, Dr. Alex Casar, Dr. Jason Frischer, and Dr. Aaron Garrison come together to provide you the essentials on diagnosis and management of Hirschprung's Disease. Intro and outro tracks are adapted from "I dunno" by grapes, featuri
podcast20:48 · Dec 2020
DrBeen Medical Lectures: Dr. Marc Levitt, MD Discusses Hirschsprung Disease
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Dr. Marc A. Levitt, MD Discusses Hirschsprung Disease on YouTube Live with Drbeen Medical Lectures.
Link to DrBeen website: https://www.drbeen.com
video53:42 · Dec 2022
Hirschsprung
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Welcome to an ePiPS special with Dr. Marc Levitt! I am here today at the 50th Anniversary of APSA in Boston discussing the diagnosis and management of Hirschspr
podcast22:45 · Jul 2026
Hirschsprung-associated enterocolitis in children: An ERNICA animation for parents and families
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Animation video [in English]. Target audience: Parents and families. The video could also be used as an explanatory tool by healthcare professionals.
For further details about this condition, possible complications and specialised care,
video3:23 · Dec 2023
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Expert statements from the recordings in this collection.
Hirschsprung
Maternal magnesium sulfate or other tocolytic medications can cause significant ileus in the newborn that mimics Hirschsprung's disease.
clinicalMarc Levitt0:55 ↗
Hypothyroidism and opiate exposure (maternal addiction or overdose transmitted to baby) can present with abdominal distension and delayed meconium passage mimicking Hirschsprung's disease.
clinicalMarc Levitt0:55 ↗
Milk protein allergy in a fed baby can mimic Hirschsprung's disease on x-ray, and irrigations help even when it is not Hirschsprung's.
clinicalMarc Levitt0:55 ↗
Ten percent of patients with meconium plug have Hirschsprung's disease, so suction rectal biopsy should be performed even after successful plug passage.
epidemiologicalMarc Levitt2:00 ↗
After meconium plug passage, the contrast study should be repeated because the initial study with plug present will show dilated rectosigmoid, but the repeat study will reveal the transition zone more clearly.
clinicalMarc Levitt3:00 ↗
In total colonic Hirschsprung's disease, there is often no obvious transition zone on contrast study.
clinicalMarc Levitt3:00 ↗
Suction rectal biopsy is the gold standard for diagnosing Hirschsprung's disease, and some centers proceed directly to biopsy without contrast study.
clinicalMarc Levitt4:00 ↗
Contrast study serves as a surgical GPS map of the colon anatomy and is preferred before operating, even though biopsy alone can rule out Hirschsprung's.
opinionMarc Levitt4:00 ↗
The physiologic obstruction in Hirschsprung's disease leads to stasis, bacterial overgrowth, and bacterial translocation because mucosal integrity is abnormal.
clinicalMarc Levitt4:42 ↗
A constipated baby without Hirschsprung's disease will not develop enterocolitis because their mucosal integrity and IgA levels are normal.
clinicalMarc Levitt4:42 ↗
Down syndrome patients with Hirschsprung's disease have worse enterocolitis because they have a weaker immune barrier.
clinicalMarc Levitt4:42 ↗
Irrigation protocol: use a 20 French soft silicone Foley catheter with warm saline in 10-20cc aliquots, washing the inside of the colon by injecting, allowing drip-back, advancing the catheter a few centimeters, and repeating for up to 30 minutes.
clinicalMarc Levitt5:44 ↗
Irrigations should be performed two to three times per day and require a written protocol so nurses know exactly what is expected.
clinicalMarc Levitt5:44 ↗
If irrigations are performed correctly but do not reach the transition zone, the baby will remain distended and irrigations will not be effective.
clinicalMarc Levitt5:44 ↗
When irrigations fail despite correct technique, the surgeon must decide between a leveling colostomy (bringing dilated bowel to surface, ideally with frozen section confirmation) or an ileostomy with colonic biopsies.
clinicalMarc Levitt7:00 ↗
Ileostomy does not require intraoperative pathology at 3 AM, the baby will thrive, and full colonic pathology data can be obtained later, but it requires three operations instead of two.
clinicalMarc Levitt7:30 ↗
In regions where ileostomy management is difficult and babies can dehydrate quickly, ileostomy may not be appropriate.
clinicalMarc Levitt7:30 ↗
A leveling colostomy is usually accurate when placed in dilated bowel to the surgeon's eye, but the risk is opening a colostomy still in the transition zone.
clinicalMarc Levitt7:30 ↗
A loop ileostomy where both limbs are equal is inappropriate because stool will jump across and fill the aganglionic segment, causing continued distension and potential enterocolitis despite diversion.
clinicalMarc Levitt9:26 ↗
A Turnbull ileostomy (cutting the bowel completely on one side of the loop, intussuscepting it over a finger to create an end-stoma appearance with flat distal opening) or a divided ileostomy with proximal end brought up and distal limb tacked to it are both appropriate diversion techniques.
clinicalMarc Levitt9:26 ↗
Post-pull-through patients present with two distinct problems: obstruction (chronic distension, enterocolitis episodes, failure to thrive) or soiling (no distension, no enterocolitis, uncontrolled stooling).
clinicalMarc Levitt11:51 ↗
Anatomic causes of post-pull-through obstruction include inadequate Soave cuff (not cut enough, rolled up, or refused), twisted pull-through (180 or 360 degrees), Duhamel spur (two lumens not successfully joined), large Duhamel pouch reaching into pelvis, stricture, and transition zone pull-through.
clinicalMarc Levitt12:40 ↗
A Soave cuff feels like a rubbery circumferential ring outside the pull-through on digital exam.
clinicalMarc Levitt12:40 ↗
A twisted pull-through prevents the examining finger from entering the pelvis; on abdominal palpation you feel like you are hitting a wall.
clinicalMarc Levitt12:40 ↗
Contrast study may show a cuff by revealing extra presacral space on lateral view; the pull-through should hug the sacrum, and a cuff pushes it forward.
clinicalMarc Levitt12:40 ↗
In Duhamel patients, biopsy must be taken from the posterior wall because the anterior wall is the original aganglionic rectum.
clinicalMarc Levitt15:00 ↗
If anatomic causes and pathology are normal in an obstructed post-pull-through patient, the problem is non-relaxing sphincters, and empiric Botox is appropriate.
clinicalMarc Levitt15:00 ↗
Every child born with Hirschsprung's disease has 100% potential for bowel control because the continence mechanism is normal and the sphincters are strong, not weak.
clinicalMarc Levitt16:13 ↗
This is very different from anorectal malformation, where associated spinal problems, poor sacrum, or poor muscles can prevent continence despite a perfect operation.
clinicalMarc Levitt16:13 ↗
Overstretching of sphincters or starting transanal dissection too low (removing the dentate line) will cause iatrogenic fecal incontinence.
clinicalMarc Levitt17:10 ↗
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