Fecal incontinence in children: treatment with percutaneous cecostomy tube placement--a prospective study.
OBJECTIVE
To evaluate the technique used for and long-term results of percutaneous cecostomy tube placement for the treatment of fecal incontinence in children.


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.


CONCLUSIONS
Percutaneous cecostomy and antegrade enemas are very successful in achieving fecal continence and patient independence and acceptability, with minimal early and late complications.
Chait
P G
PG
Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.
Shandling
B
B
Richards
H M
HM
Connolly
B L
BL
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001006:Anus, Imperforate / Q000601:surgery; D001835:Body Weight; D002429:Cecal Diseases / Q000209:etiology; D002431:Cecostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D002988:Cloaca / Q000002:abnormalities; D003248:Constipation / Q000209:etiology; D004733:Enema / Q000009:adverse effects; D004868:Equipment Failure; D005242:Fecal Incontinence / Q000601:surgery* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006097:Granulation Tissue / Q000473:pathology; D006627:Hirschsprung Disease / Q000601:surgery; D006801:Humans; D007249:Inflammation; D007415:Intestinal Obstruction / Q000209:etiology; D008297:Male; D010710:Phosphates / Q000009:adverse effects; D010865:Pilot Projects; D011446:Prospective Studies; D012835:Silver Nitrate / Q000627:therapeutic use; D016135:Spinal Dysraphism / Q000601:surgery; D013536:Suture Techniques; D014839:Vomiting / Q000209:etiology
D000900:Anti-Bacterial Agents; D010710:Phosphates; D012835:Silver Nitrate