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Ten-year experience using antegrade enemas in children.

Research paper by Suzanne M SM Mugie, Rodrigo S RS Machado, Hayat M HM Mousa, Jaya B JB Punati, Mark M Hogan, Marc A MA Benninga, Carlo C Di Lorenzo

Indexed on: 12 Jun '12Published on: 12 Jun '12Published in: The Journal of Pediatrics



Abstract

To describe a single-center, 10-year experience with the use of antegrade enemas.Retrospective analysis of 99 patients treated with antegrade enemas at Nationwide Children's Hospital.Study subjects (median age 8 years) were followed for a mean time of 46 months (range 2-125 months) after cecostomy placement. Seventy-one patients had the cecostomy placed percutaneously and 28 by surgery. Thirty-five patients had functional constipation and 64 patients an organic disease (spinal abnormalities, cerebral palsy, imperforate anus, Hirschsprung's disease). While using antegrade enemas, 71% became symptom-free, in 20 subjects symptoms improved, in 2 subjects symptoms did not change, and in 7 subjects symptoms worsened. Poor outcome was associated with surgical placement of the cecostomy (P < .001), younger age (P = .02), shorter duration of symptoms (P = .01), history of Hirschsprung's disease (P = .05), cerebral palsy (P = .03), previous abdominal surgery (P = .001), and abnormal colonic manometry (P = .004). In 88%, successful irrigation solution included use of a stimulant laxative, and subjects who used a stimulant did significantly better (P < .001) than subjects who started without a stimulant. In 13 patients, the cecostomy was removed 49.7 months after placement without recurrence of symptoms. Major complications occurred in 12 patients and minor complications in 47.Antegrade enemas represent a successful and relatively safe therapeutic option in children with severe defecatory disorders. Prognostic factors are identified.