Original ArticleTen-Year Experience Using Antegrade Enemas in Children
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)
- et al.
Pathophysiology of pediatric fecal incontinence
Gastroenterology
(2004) - et al.
Impact of cecostomy and antegrade colonic enemas on management of fecal incontinence and constipation: 10 years of experience in pediatric population
J Pediatr Surg
(2008) - et al.
Preliminary report, antegrade continence enema
Lancet
(1990) - et al.
Percutaneous colonoscopic cecostomy for management of chronic constipation in children
Gastrointest Endosc
(2001) - et al.
Percutaneous cecostomy: a new technique in the management of fecal incontinence
Dis Colon Rectum
(1996) - et al.
The MACE procedure: experience in the United Kingdom
J Pediatr Surg
(1999) - et al.
The Malone antegrade continence enema procedure: quality of life and family perspective
J Urol
(2003) - et al.
Is the outcome of the left colon antegrade continence enema better than that of the right colon antegrade continence enema?
J Pediatr Surg
(2009) What happens to children with idiopathic constipation who receive an antegrade continent enema? An actuarial analysis of 80 consecutive cases
J Pediatr Surg
(2009)- et al.
The Malone antegrade continence enema procedure: the Amsterdam experience
J Pediatr Surg
(2011)
Antegrade colonic enemas and intestinal diversion are highly effective in the management of children with intractable constipation
J Pediatr Surg
Colonic motility after surgery for Hirschsprung's Disease
Am J Gastroenterol
Colonic manometry as predictor of cecostomy success in children with defecation disorders
J Pediatr Surg
Cited by (46)
Pediatric and adolescent GI motility disorders and management
2023, Handbook of Gastrointestinal Motility and Disorders of Gut-Brain Interactions, Second EditionLower Gastrointestinal Functional and Motility Disorders in Children
2021, Pediatric Clinics of North AmericaCitation Excerpt :Surgical interventions should be considered only when all available medical therapies have failed and symptoms are significantly affecting quality of life.38 ACE via percutaneous cecostomy or appendicostomy can be used to successfully achieve colonic emptying and continence.53–55 In more severe cases or those not responsive to ACE, ostomies or colectomy can be considered with CM guidance.52
Constipation: Beyond the Old Paradigms
2018, Gastroenterology Clinics of North AmericaSacral neuromodulation for constipation and fecal incontinence in children
2017, Seminars in Colon and Rectal SurgerySacral nerve stimulation allows for decreased antegrade continence enema use in children with severe constipation
2017, Journal of Pediatric Surgery
The authors declare no conflicts of interest.