[Success of antegrade enemas in children with functional constipation].
OBJECTIVE
To assess the benefit of antegrade enemas via cecostomy in children with functional constipation unresponsive to medical treatment.


METHODS
A retrospective chart review identified 19 children (12 male, age 10.4 +/- 4.3 yrs) who from 1998-2001 underwent placement of a cecostomy for administration of antegrade enemas. All children were neurologically normal, suffered from functional constipation; all had a history of using multiple medications, having daily soiling, and 65% had prior hospitalizations due to fecal impaction. Sixteen of 19 children had undergone colonic manometry which ruled out colonic inertia. One of 3 irrigation solutions: polyethylene glycol (65%), saline and glycerin solution mix (10%) and phosphate enema (25%) administered through the cecostomy everyday in 14 children or every other day in 5 children. We used a questionnaire to interview caregivers, a mean of 21.1 +/- 24.9 mo after cecostomy placement.


RESULTS
In all patients antegrade enemas led to significant improvement of: bowel movements/wk (7.4 vs. 1.4, p < 0.001), soiling accidents/wk (1.1 vs. 6.1, p < 0.001), emotional health score (3.8 vs. 1.8, p < 0.001), overall health score (3.7 vs. 1.8, p < 0.001), number of medications for constipation (0.8 vs. 4.2, p < 0.001), number of missed school days/mo (1.3 vs. 10.5, p < 0.001), and number of physician office visits/yr (7.7 vs. 24.1, p < 0.002). Eight patients have been able to discontinue the use of the antegrade enemas within a mean of 19.9 +/- 14.2 mo after beginning treatment.


CONCLUSIONS
Antegrade enemas are an alternative effective way for treating severe cases of functional constipation unresponsive to medical management.
Pensabene
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Dipartimento di Pediatria, Divisione di Gastroenterologia Pediatrica, Children's Hospital di Pittsburgh, 3705 Fifth Avenue at DeSoto Street, Pittsburgh, Pennsylvania 15213, USA.
Youssef
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NN
Di Lorenzo
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C
D002431:Cecostomy; D002648:Child; D003248:Constipation / Q000601:surgery / Q000628:therapy*; D004733:Enema; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies