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Antegrade colonic enemas

A C Dick1, W A McCallion, S Brown

  • 1Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, UK.

The British Journal of Surgery
|May 1, 1996
PubMed
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The antegrade colonic enema procedure offers a continent stoma for children with refractory constipation or soiling. This surgical approach achieved success in 11 of 13 pediatric patients, avoiding traditional sigmoid colostomy.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology

Background:

  • Refractory constipation and fecal soiling significantly impact children's quality of life.
  • Previous surgical interventions like pull-through procedures for Hirschsprung's disease or anorectal malformations may not resolve these issues.
  • Alternative management strategies are crucial for complex pediatric cases.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of the antegrade colonic enema procedure in pediatric patients.
  • To assess the success rate of achieving a continent stoma in children with severe constipation or fecal soiling.
  • To compare the antegrade approach with traditional sigmoid colostomy.

Main Methods:

  • Retrospective review of 13 children (aged 6-14) who underwent antegrade colonic enema.

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  • Surgical technique involved creating a catheterizable conduit using the appendix or a cecal tube.
  • Patient data included previous surgeries, underlying conditions (Hirschsprung's disease, anorectal malformations, spina bifida, functional constipation), and post-operative outcomes.

    • Main Results:

    • 11 out of 13 children achieved a continent stoma.
    • Five patients experienced minor morbidity.
    • Six patients required additional surgery, and two ultimately needed a sigmoid colostomy.

    Conclusions:

    • The antegrade colonic enema procedure is an effective surgical option for achieving a continent stoma in pediatric patients with refractory constipation or fecal soiling.
    • This technique offers a viable alternative to sigmoid colostomy, improving outcomes for complex cases.
    • While some morbidity and need for further procedures were noted, the overall success rate in achieving continence was high.