Original Article
Ten-Year Experience Using Antegrade Enemas in Children

https://doi.org/10.1016/j.jpeds.2012.04.042Get rights and content

Objective

To describe a single-center, 10-year experience with the use of antegrade enemas.

Study design

Retrospective analysis of 99 patients treated with antegrade enemas at Nationwide Children's Hospital.

Results

Study subjects (median age 8 years) were followed for a mean time of 46 months (range 2-125 months) after cecostomy placement. Seventy-one patients had the cecostomy placed percutaneously and 28 by surgery. Thirty-five patients had functional constipation and 64 patients an organic disease (spinal abnormalities, cerebral palsy, imperforate anus, Hirschsprung's disease). While using antegrade enemas, 71% became symptom-free, in 20 subjects symptoms improved, in 2 subjects symptoms did not change, and in 7 subjects symptoms worsened. Poor outcome was associated with surgical placement of the cecostomy (P < .001), younger age (P = .02), shorter duration of symptoms (P = .01), history of Hirschsprung's disease (P = .05), cerebral palsy (P = .03), previous abdominal surgery (P = .001), and abnormal colonic manometry (P = .004). In 88%, successful irrigation solution included use of a stimulant laxative, and subjects who used a stimulant did significantly better (P < .001) than subjects who started without a stimulant. In 13 patients, the cecostomy was removed 49.7 months after placement without recurrence of symptoms. Major complications occurred in 12 patients and minor complications in 47.

Conclusions

Antegrade enemas represent a successful and relatively safe therapeutic option in children with severe defecatory disorders. Prognostic factors are identified.

Section snippets

Methods

We performed a retrospective analysis of 99 patients (57 boys and 42 girls) who received a cecostomy between January 2000 and June 2010 for administration of antegrade enemas at Nationwide Children's Hospital, Columbus, Ohio. We identified the patients in our hospital data warehouse, using Current Procedural Terminology codes. All patients had been followed by a pediatric gastroenterologist with a special expertise in intestinal motility. The frequency of clinic visits depended on the clinical

Results

The median age of the 99 patients at the time of the procedure was 8 year (range 2-22 years; Table I). They were followed for a mean time of 46 months after the procedure, ranging from 2-125 months. Sixty-five children had a history of lifelong symptoms, in the other 34 subjects the mean duration of symptoms at time of the procedure was 5.9 years, with a mean age of 2 year at the start of the symptoms. Fifty-four patients had been previously hospitalized at least once for fecal disimpaction.

Discussion

This study confirms that antegrade enemas are a successful therapeutic option in children with severe, treatment-resistant constipation and/or fecal incontinence. After using daily antegrade enemas, 91% of the patients had a satisfactory outcome, with 71% becoming symptom-free. In the other 20% of the patients, symptoms improved significantly. This is consistent with earlier reported success rates (65%-89%) in children with either functional or organic constipation refractory to other

References (26)

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The authors declare no conflicts of interest.

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