Ileus and Intra-Abdominal Hypertension due to Phosphate- Containing Enema

Area of Science:

• Pediatric Gastroenterology
• Nephrology
• Critical Care Medicine

Background:

• Fleet enemas, commonly used for constipation, carry risks including cardiac insufficiency, renal failure, and electrolyte disturbances.
• Phenylketonuria (PKU) is a metabolic disorder that can be associated with chronic constipation.
• Phosphate enemas can lead to severe hyperphosphatemia and hypocalcemia, especially in susceptible individuals.

Observation:

• A 7-year-old girl with PKU and constipation presented with seizures, vomiting, and abdominal distention after receiving a fleet enema.
• Initial laboratory findings revealed hypocalcemia and hyperphosphatemia, with ECG showing a prolonged QT interval.
• Progressive abdominal distention led to elevated intra-abdominal pressure (IAP) of 19.5 mmHg, prompting intervention.

Findings:

• Treatment with gastric and colonic decompression, along with intravenous calcium gluconate, resulted in clinical stabilization.
• Serum calcium and phosphorus levels normalized (8.8 mg/dl and 4.0 mg/dl, respectively) within 2 days.
• Abdominal distention resolved, with a subsequent IAP measurement of 3.5 mmHg.

Implications:

• Intra-abdominal pressure (IAP) monitoring serves as a valuable tool for assessing and managing progressive abdominal distention in patients treated with phosphate enemas.
• This case highlights the potential severity of fleet enema complications, particularly in pediatric patients with underlying metabolic conditions.
• Early recognition and management of electrolyte imbalances and increased IAP are critical for favorable outcomes.