Optimization of Pediatric Bowel Management Using an Antegrade Enema Troubleshooting Algorithm.

Area of Science:

• Pediatric surgery
• Gastroenterology
• Bowel management therapy

Background:

• Defining successful flushing for fecal continence.
• Evaluating patient experiences with appendicostomy/cecostomy flush difficulties.
• Developing a structured algorithm for managing flush issues.

Purpose of the Study:

• To evaluate the efficacy of a newly designed algorithm for managing flush difficulties in pediatric patients.
• To differentiate between issues requiring surgical intervention versus changes in bowel management therapy (BMT).

Main Methods:

• An algorithm was developed categorizing flush issues into before, during, and after flushing.
• Retrospective evaluation of 29 pediatric patients (aged <20 years) with flush issues from September 2018 to August 2019.
• Analysis of outcomes including changes in BMT and the need for additional surgery.

Main Results:

• The majority of flush issues (63%) occurred after flushing, while 29% occurred before and 9% during.
• Issues arising before flushing had an 80% rate of requiring surgical intervention.
• Issues occurring during or after flushing were managed with BMT changes in 92% of cases.

Conclusions:

• Most flush issues can be effectively managed by adjusting bowel management therapy (BMT).
• The developed algorithm aids in identifying which flush issues may necessitate surgical intervention.
• The algorithm helps pinpoint potential problems when patients do not respond to their current flush regimen.