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Whole bowel irrigation in children: prolonged post-irrigation diarrhea due to isotonic saline
M E Senocak1, N Büyükpamukçu, A Hiçsönmez
1Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara.
Insights
Whole bowel irrigation (WBI) is a safe and generally well-tolerated procedure for pediatric surgical preparation. Saline WBI may cause diarrhea, while lactated Ringer's solution may lead to bile-stained fluid.
Area of Science:
- Pediatric Gastroenterology
- Surgical Preparation
- Medical Procedures
Background:
- Whole bowel irrigation (WBI) is utilized to cleanse the gastrointestinal tract before medical procedures.
- Limited data exists on the safety and efficacy of WBI in pediatric populations.
Purpose of the Study:
- To evaluate the safety, tolerance, and effectiveness of whole bowel irrigation in children undergoing surgery or rectoscopy.
- To identify potential complications and differences between saline and lactated Ringer's solutions for WBI.
Main Methods:
- Sixty children (aged 2-16 years) underwent WBI using either isotonic saline or lactated Ringer's solution.
- Vital signs, electrolytes, and procedural outcomes were monitored.
- Adverse events and preparation quality were recorded.
Main Results:
- WBI was generally well-tolerated with stable vital signs and minimal electrolyte disturbances.
- Diarrhea occurred in 74.4% of patients receiving saline WBI, lasting 2-5 days.
- Vomiting (15%) and abdominal cramps (3.3%) were observed; edema in one patient (1.6%).
- Preparation quality was satisfactory in 75% of cases.
- Bile-stained fluid was noted exclusively in patients receiving lactated Ringer's solution.
Conclusions:
- Whole bowel irrigation is a safe and effective bowel preparation method for pediatric patients.
- Saline WBI is associated with a high incidence of post-procedural diarrhea.
- Lactated Ringer's solution may produce distinct intraluminal fluid characteristics requiring further investigation.
Abstract:
Whole bowel irrigation (WBI) was performed in 60 children aged two to 16 yrs (mean 5.1 +/- 0.5 yrs) in preparation for surgery (n: 59) and rectoscopy (n: 1). Isotonic saline (n: 43) and lactated Ringer's solutions (n: 17) were infused for irrigation. Vital signs remained stable during the procedure. Negligible electrolytic alterations were encountered. In general, WBI was well tolerated by all the patients. Two (3.3%) patients had abdominal cramps, vomiting was observed in nine (15%) and edema developed in one (16%). The results of the preparation were assessed as satisfactory in 45 cases (75%), adequate in 10 cases (16.6%) and poor in 5 cases (8.3%). Diarrhea, as a complication of saline, has not been reported previously in the literature, but was observed in 32 of our cases (74.4%), and lasted 2-5 days (mean 3.38 +/- 0.7 days) after irrigation. In addition, it is noteworthy that bile-stained intraluminal clear fluid was seen only in the patients who had been irrigated with lactated Ringer's solution. Our research related to this observation is continuing.