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Management of intractable constipation with antegrade enemas in neurologically intact children
Nader N Youssef1, Edward Barksdale Jr, Janet M Griffiths
1Division of Pediatric Gastroenterology, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA. youssen@chplink.chp.edu
Insights
Antegrade enemas via cecostomy significantly improve severe constipation in children. This safe and effective treatment option enhances bowel function, reduces accidents, and improves quality of life for pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Surgical Interventions
- Bowel Management
Background:
- Severe constipation in children often necessitates advanced treatment strategies.
- Referral to tertiary care centers indicates complex pediatric constipation cases.
- Neurologically normal children with refractory constipation require effective management options.
Purpose of the Study:
- To evaluate the efficacy of antegrade enemas administered through a cecostomy in pediatric patients with severe constipation.
- To assess the impact of this intervention on clinical outcomes and quality of life.
Main Methods:
- A cohort of 12 neurologically normal children with severe constipation underwent cecostomy placement between 1997 and 1999.
- Caregiver questionnaires were used for follow-up assessment approximately 13 months post-procedure.
- Data collected included bowel movement frequency, soiling accidents, pain, emotional and overall health scores, medication use, school absenteeism, and healthcare visits.
Main Results:
- Antegrade enemas resulted in significant improvements across all measured parameters, including increased bowel movements, reduced soiling, decreased abdominal pain, and enhanced emotional and overall health scores.
- There was a notable reduction in medication use, missed school days, and physician visits.
- Minor adverse events such as skin breakdown and tube dislodging occurred, and five patients discontinued treatment.
Conclusions:
- Antegrade enemas delivered via cecostomy represent a safe and satisfactory therapeutic option for neurologically intact children suffering from severe, medically refractory constipation.
- This approach offers a viable solution for improving the quality of life in this patient population.
Objectives:
To assess the benefit of antegrade enemas in children with severe constipation who were referred to a tertiary care center.
Methods:
From 1997 to 1999, 12 children (9 male, aged 8.7 +/- 4.4 years) underwent cecostomy placement. All children were neurologically normal and had been extensively examined to rule out organic causes of constipation. Follow-up included a questionnaire to interview caregivers 13.1 +/- 8.5 months after cecostomy placement.
Results:
For all children, antegrade enemas led to improvement in the number of bowel movements / week (7.1 versus 1.4, P < 0.005), number of soiling accidents / week (1.0 versus 4.7, P < 0.01), abdominal pain score (0.9 versus 2.9, P < 0.005), emotional health score (3.6 versus 1.9, P < 0.005), overall health score (3.6 versus 1.7, P < 0.005), number of medications used for constipation (0.8 versus 4.0, P < 0.005), number of missed school days / month (1.5 versus 7.5, P < 0.02), and number of physician office visits / year (9.2 versus 24.0, P < 0.05). Irrigation solutions used for the antegrade enemas included polyethylene glycol (67%), saline and glycerin solution (25%), and phosphate enema (8%), administered everyday in seven children and every other day in five children. Adverse events included skin breakdown and granulation tissue in one patient, leakage of irrigation solution in one patient, and dislodging of the tube in two patients. Five patients discontinued the use of antegrade enemas within a mean of 14.6 +/- 9.1 months after beginning treatment.
Conclusion:
Antegrade enemas through a cecostomy are a safe and satisfactory option for children who are neurologically intact and who have severe constipation that does not respond to medical treatment.
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