A term male infant with Hirschsprung's disease underwent an uncomplicated laparoscopic-assisted 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.
RhderK.J., TurnerD.A., CheifetzI.M.K.Extracorporeal membrane oxygenation for neonatal and pediatric respiratory failure: an evidence-based review of the past decade (2001–2012).Pediatr Crit Care Med2013; 14: 851–61.
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LamM.C., YangP.T., SkippenP.W.Abdominal compartment syndrome complicating paediatric extracorporeal life support: diagnostic and therapeutic challenges.Anaesth Intensive Care2008; 36: 726–31.
4.
NealM.D., AlverdyJ.C., HallD.E.Diverting loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for the treatment of severe, complicated Clostridium difficile associated disease.Ann Surg2011; 254: 423–9.
