Despite appropriate treatment this serious complication of Hirschsprung's disease can develop at any stage and may be the presenting condition. Profuse, often bloody diarrhea with abdominal distension is the main presenting symptom. Vomiting and fever may be present and the child may become rapidly unwell and dehydrated. Treatment is initially with fluid resuscitation and intestinal decompression by means of a nasogas-tric tube. Rectal examination should be performed as it may produce an explosion of foul-smelling gas and stools which aids diagnosis and intestinal decompression. The bowel is rested, during which time parenteral nutrition may be considered. Our practice is to give enteral vancomycin, targeting Clostridium species which are often implicated.
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