Outcome of the antegrade colonic enema procedure in children with chronic constipation.
BACKGROUND
Chronic constipation and fecal incontinence in children related to pelvic trauma, congenital anomalies, or malignancy will eventually lead to significant social and psychologic stress. Maximal medical treatment (daily enemas and laxatives) can also be difficult to maintain in many children.


METHODS
At our children's hospital, 11 children with chronic constipation or fecal incontinence or both underwent the antegrade colonic enema (ACE) procedure. The operation involved constructing a conduit into the cecum using either the appendix (n = 8) or a "pseudo-appendix" created from a cecal flap (n = 3). We report our surgical results.


RESULTS
Mean child age was 9.6 (5 to 18) years. With a mean follow-up of 14 (6 to 24) months, 10 of the children (91%) had significant improvement and 7 children (64%) are completely clean with no soiling and controlled bowel movements after irrigation.


CONCLUSIONS
Regular colonic lavage after the ACE procedure allows children with chronic constipation and fecal incontinence to regain normal bowel habits and a markedly improved lifestyle. This procedure should be considered before colostomy in children and adults for the treatment of fecal incontinence from a variety of causes.
Kokoska
E R
ER
Department of Surgery, Division of Pediatric Surgery, Saint Louis University Health Sciences Center and Cardinal Glennon Children's Hospital, 1465 S. Grand Blvd., St. Louis, MO 63104, USA.
Keller
M S
MS
Weber
T R
TR
D000293:Adolescent; D001065:Appendix / Q000601:surgery; D002432:Cecum / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003248:Constipation / Q000601:surgery*; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D016896:Treatment Outcome