Tube sigmoidostomy: a modification of the antegrade colonic evacuation

The Malone appendicostomy enema has established its place in the treatment of paediatric faecal incontinence. More recently, the laparoscopic appendicostomy enema has gained favour. In the situation where the appendix has already been removed, caecal stomal tubes can be constructed to facilitate antegrade colonic wash-outs. These techniques may not provide an accept-able result if there is a significant time delay from the introduction of the enema to the result. Wash-outs through the more distal colon -- either by retrograde techniques with a rectal tube or, more recently, through a plastic stomal device inserted percutaneously into the sigmoid colon (the Chait tube) -- can result in rapid evacuation. Rectal wash-outs may not provide an adequate lavage and can be technically difficult for some children to perform, while many other children find external devices cosmetically unacceptable. We present a modification of this distal colonic technique that can allow greater control, can be used in the absence of an appendix and avoids the need for an external device.

Two paediatric patients with spina bifida and faecal incontinence underwent tube sigmoidostomy formation. In both patients, the appendix was not available to be used for colonic wash-outs.

Both patients reported excellent success with this procedure. They are continent, able to cannulate the stoma and irrigate independently.

The technique can provide excellent continence control in patients who are not successful with a right-sided Malone appendicostomy. It also overcomes the need for a catheterizable appendix, and an external device.