title: Management of intractable constipation with antegrade enemas in neurologically intact children.
abstract: OBJECTIVE
  To assess the benefit of antegrade enemas in children with severe constipation who were referred to a tertiary care center.
  
  
  METHODS
  From 1997 to 1999, 12 children (9 male, aged 8.7 +/- 4.4 years) underwent cecostomy placement. All children were neurologically normal and had been extensively examined to rule out organic causes of constipation. Follow-up included a questionnaire to interview caregivers 13.1 +/- 8.5 months after cecostomy placement.
  
  
  RESULTS
  For all children, antegrade enemas led to improvement in the number of bowel movements / week (7.1 versus 1.4, P < 0.005), number of soiling accidents / week (1.0 versus 4.7, P < 0.01), abdominal pain score (0.9 versus 2.9, P < 0.005), emotional health score (3.6 versus 1.9, P < 0.005), overall health score (3.6 versus 1.7, P < 0.005), number of medications used for constipation (0.8 versus 4.0, P < 0.005), number of missed school days / month (1.5 versus 7.5, P < 0.02), and number of physician office visits / year (9.2 versus 24.0, P < 0.05). Irrigation solutions used for the antegrade enemas included polyethylene glycol (67%), saline and glycerin solution (25%), and phosphate enema (8%), administered everyday in seven children and every other day in five children. Adverse events included skin breakdown and granulation tissue in one patient, leakage of irrigation solution in one patient, and dislodging of the tube in two patients. Five patients discontinued the use of antegrade enemas within a mean of 14.6 +/- 9.1 months after beginning treatment.
  
  
  CONCLUSIONS
  Antegrade enemas through a cecostomy are a safe and satisfactory option for children who are neurologically intact and who have severe constipation that does not respond to medical treatment.
authors.affiliation: Division of Pediatric Gastroenterology, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA. youssen@chplink.chp.edu
authors.forename: Nader N
authors.initials: NN
authors.lastname: Youssef
authors.forename: Edward
authors.initials: E
authors.lastname: Barksdale Jr
authors.forename: Janet M
authors.initials: JM
authors.lastname: Griffiths
authors.forename: Alejandro F
authors.initials: AF
authors.lastname: Flores
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Lorenzo
mesh_terms: D002431:Cecostomy; D002648:Child; D003248:Constipation / Q000628:therapy*; D004733:Enema; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies