Acute Abdominal Pain in Children and Adolescents-Can Enemas Reduce Unnecessary Inpatient Admissions?

Constipation is a common cause of pediatric acute abdominal pain and, consequently, may be a frequent cause for presenting to emergency departments. Data on the effectiveness of administering enemas in the emergency department are scarce. This study aimed to evaluate the effect of enemas in the emergency department on symptom relief and inpatient admission rates in patients with pediatric acute abdominal pain, including adverse events.

We retrospectively analyzed 1,723 pediatric acute abdominal pain patients aged 3-17 years presenting to the emergency department of our tertiary pediatric surgery center from 2018 to 2019. The clinical course, the rate of inpatient admission, the rate of surgical intervention, and final diagnosis were assessed in patients who did or did not receive an enema.

Symptom relief and consecutive discharge from the emergency department were more frequent in the enema group (81% vs. 67% and p<0.0001). Fewer patients in the enema-group were operated on (8% vs. 13% and p=0.0003). The rate of revisits to the emergency department within 14 days, the rate of surgery after revisits, the rate of intraoperatively confirmed appendicitis, and the rate of patients admitted but managed conservatively did not differ between the two groups. No enema-related complication was recorded.

Administering an enema to otherwise healthy children and adolescents with acute abdominal pain is safe. Administering enemas to pediatric acute abdominal pain patients may decrease the rate of inpatient admissions. Discharging patients in whom an enema-prompted bowel movement has led to the relief of symptoms does not lead to an increased rate of readmissions or surgery.