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[Success of antegrade enemas in children with functional constipation]
L Pensabene1, N N Youssef, C Di Lorenzo
1Dipartimento di Pediatria, Divisione di Gastroenterologia Pediatrica, Children's Hospital di Pittsburgh, 3705 Fifth Avenue at DeSoto Street, Pittsburgh, Pennsylvania 15213, USA.
Insights
Antegrade enemas via cecostomy significantly improve bowel function and quality of life in children with severe functional constipation. This treatment offers an effective alternative for patients unresponsive to conventional medical therapies.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
Context:
- Functional constipation is a common pediatric issue.
- Severe cases often prove refractory to standard medical treatments.
- Cecostomy offers a route for antegrade enema administration.
Purpose:
- To evaluate the efficacy of antegrade enemas administered via cecostomy.
- To assess outcomes in pediatric patients with intractable functional constipation.
Summary:
- A retrospective review of 19 children with functional constipation unresponsive to medical treatment was conducted.
- Antegrade enemas via cecostomy led to significant improvements in bowel movements, soiling, health scores, and reduced medication use.
- Eight patients eventually discontinued antegrade enema use.
Impact:
- Antegrade enemas represent a viable and effective treatment option for severe pediatric functional constipation.
- This approach can substantially enhance patients' quality of life and reduce healthcare utilization.
- It provides an alternative for cases resistant to conventional therapies.
Aim:
To assess the benefit of antegrade enemas via cecostomy in children with functional constipation unresponsive to medical treatment.
Methods:
A retrospective chart review identified 19 children (12 male, age 10.4 +/- 4.3 yrs) who from 1998-2001 underwent placement of a cecostomy for administration of antegrade enemas. All children were neurologically normal, suffered from functional constipation; all had a history of using multiple medications, having daily soiling, and 65% had prior hospitalizations due to fecal impaction. Sixteen of 19 children had undergone colonic manometry which ruled out colonic inertia. One of 3 irrigation solutions: polyethylene glycol (65%), saline and glycerin solution mix (10%) and phosphate enema (25%) administered through the cecostomy everyday in 14 children or every other day in 5 children. We used a questionnaire to interview caregivers, a mean of 21.1 +/- 24.9 mo after cecostomy placement.
Results:
In all patients antegrade enemas led to significant improvement of: bowel movements/wk (7.4 vs. 1.4, p < 0.001), soiling accidents/wk (1.1 vs. 6.1, p < 0.001), emotional health score (3.8 vs. 1.8, p < 0.001), overall health score (3.7 vs. 1.8, p < 0.001), number of medications for constipation (0.8 vs. 4.2, p < 0.001), number of missed school days/mo (1.3 vs. 10.5, p < 0.001), and number of physician office visits/yr (7.7 vs. 24.1, p < 0.002). Eight patients have been able to discontinue the use of the antegrade enemas within a mean of 19.9 +/- 14.2 mo after beginning treatment.
Conclusion:
Antegrade enemas are an alternative effective way for treating severe cases of functional constipation unresponsive to medical management.