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Therapeutic cecostomy tubes in infants with imperforate anus and caudal agenesis
Steven L Lee1, Susan Rowell, Stephen K Greenholz
1Department of Surgery, Division of Pediatric Surgery, University of California at Davis, Medical Center, Sacramento, CA, USA.
Insights
Antegrade enemas using cecostomy tubes effectively manage bowel function in infants with high imperforate anus and caudal agenesis, reducing complications and improving outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Developmental Biology
Background:
- Caudal agenesis presents a poor prognosis for normal bowel function in children with high imperforate anus (HIA).
- Associated complications include impaction, soiling, megarectosigmoid, and psychosocial dysfunction.
- Traditional management often leads to inevitable complications and long-term challenges.
Purpose of the Study:
- To prospectively evaluate the efficacy of skin-level cecostomy tubes in infants with HIA and caudal agenesis.
- To mitigate the risks of impaction, soiling, and psychosocial dysfunction associated with poor bowel management.
- To assess antegrade enemas as a therapeutic intervention for bowel management in this high-risk pediatric population.
Main Methods:
- Prospective evaluation of 8 infants with HIA and caudal agenesis variants between 1997 and 2001.
- Placement of cecostomy tubes in conjunction with colostomy closure (n=7) or anal transposition (n=1).
- Daily antegrade colonic irrigations with modified electrolyte solutions, with a mean follow-up of 22 months.
Main Results:
- Effective daily colonic evacuation achieved in 7 out of 8 infants.
- Soiling episodes resolved with irrigation adjustments; no patient required admission for impaction.
- Minimal complications reported, including transient cramping and site discomfort; one patient required ongoing treatment for anal stricture.
Conclusions:
- Antegrade enemas via cecostomy devices are highly effective for bowel management in infants with HIA and caudal agenesis.
- Cecostomy tubes can be placed with minimal morbidity during initial reconstructive surgery.
- This procedure should be considered for all infants diagnosed with HIA and associated caudal anomalies.
Background/Purpose:
Caudal agenesis is indicative of a poor prognosis for achieving normal bowel function in children with high imperforate anus (HIA). Complications with impaction, soiling, megarectosigmoid, and adverse responses to rectal enemas are inevitable and associated with long-term psychosocial dysfunction. In an attempt to avoid these outcomes, the authors began a prospective evaluation in these high-risk patients of skin level cecostomy tubes placed in infancy.
Methods:
Between October 1997 and March 2001, 8 infants with variants of caudal agenesis underwent presumptive therapeutic placement of a cecostomy tube in conjunction with colostomy closure (n = 7) and anal transposition (n = 1). Mean age at time of cecostomy placement was 16 months. Efficacy of daily irrigations with individually modified electrolyte solutions has been evaluated over the subsequent 1 to 41 months with a mean follow-up of 22 months.
Results:
Effective daily colonic evacuation was achieved in 7 infants. Transient episodes of incomplete emptying often associated with soiling were resolved with adjustments in solution contents and volume. No patient has required admission for impaction, and only 1 patient has required rectal enemas. There have been no major complications, and minor problems with cramping, granulation tissue, and site discomfort quickly resolved. One patient with anal anastamotic stricture consistently has not responded to antegrade irrigation and continues to require intermittent rectal enemas and anal dilation. Attempts to wean the irrigations occur as the infants grow older and are able to participate in toilet training; however, in this preschool population, tapering of the frequency has been tolerated only transiently.
Conclusions:
Antegrade enemas via a cecostomy device are highly effective for bowel management in infants with HIA and caudal agenesis. They can be placed with minimal morbidity at the time of initial reconstruction or colostomy closure. Consideration of this procedure in all infants with HIA may be indicated.