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 laparoscopicassisted 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.