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Fecal incontinence in children: treatment with percutaneous cecostomy tube placement--a prospective study
P G Chait1, B Shandling, H M Richards
1Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Percutaneous cecostomy tube placement effectively treats fecal incontinence in children, leading to improved continence and independence with minimal complications. This minimally invasive procedure offers a successful long-term solution for pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Interventional Radiology
Background:
- Fecal incontinence significantly impacts children's quality of life and independence.
- Traditional treatments may have limitations, necessitating alternative approaches.
- Percutaneous cecostomy offers a minimally invasive option for managing fecal incontinence.
Purpose of the Study:
- To evaluate the technique of percutaneous cecostomy tube placement in children.
- To assess the long-term efficacy and safety of percutaneous cecostomy for fecal incontinence.
Main Methods:
- A pilot study was followed by percutaneous cecostomy tube placement in 42 pediatric patients (aged 2-20 years).
- Patients had various underlying conditions including spina bifida, imperforate anus, cloacal anomalies, and Hirschsprung disease.
- Mean follow-up was 265 days (range, 8-503 days).
Main Results:
- Successful tube placement was achieved in all patients.
- Resolution of soiling was observed in all treated children.
- Minor complications included local inflammation, postprocedural ileus, constipation, granulation tissue, and dislodged tubes, all managed effectively.
Conclusions:
- Percutaneous cecostomy with antegrade enemas is highly successful in achieving fecal continence.
- The procedure enhances patient independence and acceptability.
- Minimal early and late complications are associated with percutaneous cecostomy.
Purpose:
To evaluate the technique used for and long-term results of percutaneous cecostomy tube placement for the treatment of fecal incontinence in children.
Materials And Methods:
After an initial pilot study in 15 patients, 42 additional patients with fecal incontinence aged 2-20 (mean, 11.5) years and weighing 9.9-109.0 (mean, 39.2) kg underwent percutaneous cecostomy tube placement. Twenty-nine patients had spina bifida, nine had imperforate anus, three had cloacal anomalies, and one had Hirschsprung disease. Mean follow-up was 265 days (range, 8-503 days).
Results:
Tube placement was successful in all patients. One patient developed local inflammation after accidental early retention-suture removal, which was treated with suture replacement and intravenous antibiotics. Another developed postprocedural ileus, which resolved. Late complications included constipation in one patient (treated with diet alteration), granulation tissue in seven patients (treated with silver nitrate cautery), and accidentally dislodged tubes in three patients (two successfully replaced at home and one replaced at the radiology suite). Vomiting related to the phosphate enema occurred in two patients. Resolution of soiling was achieved in all patients.
Conclusion:
Percutaneous cecostomy and antegrade enemas are very successful in achieving fecal continence and patient independence and acceptability, with minimal early and late complications.
