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Fluid and Serum Electrolyte Disturbances as a Complication of Enemas in Hirschsprung's Disease

Patricia K. Moseley, MD; William E. Segar, MD
Am J Dis Child. 1968;115(6):714-718. doi:10.1001/archpedi.1968.02100010716013.
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HIRSCHSPRUNG'S disease, or intestinal aganglionosis, is generally characterized by abdominal distention with constipation secondary to a functional colonic obstruction; an aganglionic segment of bowel usually in the rectosigmoid area lacks coordinated propulsive contractions. Anatomically, the aganglionic portion is narrowed and the proximal colon is dilated and hypertrophied. Several complications are known to result from the compromised ability to evacuate colonic contents: intestinal obstruction, enterocolitis, spontaneous rupture of the colon, anemia, hypoproteinemia and edema, and retarded growth.1

Enemas to facilitate colonic evacuation are recommended treatment for this disease. However, because the enema may be retained and because a large surface area is available for absorption, tap-water enemas are known to produce water intoxication, and their use is not recommended. Recently the use of other types of enemas has been suggested, among them hypertonic phosphate enemas.1 Our experience with four children in whom two additional complications of enemas, hypernatremic dehydration


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