[Appendicostomy in the treatment of severe defecation disorders in children].
BACKGROUND
The Malone antegrad colonic enema (MACE) has been an option in the treatment of children with severe faecal incontinence or intractable constipation at Odense University Hospital.


METHODS
We did a retrospective review of 32 case records and questionnaires completed by the patients. Pre-existing conditions included anorectal anomaly, myelomeningocele, Hirschsprung's disease and idiopathic constipation. The mean age at operation was 8.7 years (range 4-16 years), and the mean follow-up time was 2.5 years (range 1-8 years).


RESULTS
Of the 32 patients, 31 returned the questionnaire. Three children had obtained satisfactory colonic function, and 2 patients had had a colostomy because of an unsatisfactory result. Of the remaining 26 patients, all reported improvement and 46% were completely clean. Complications related to the stoma included stomal stenosis (41%) and stomal leakage (62%), and 54% had experienced some degree of abdominal pain during the procedure. The patients' satisfaction with the MACE procedure and their improvement in general well-being was evaluated on a scale from 1 to 10 (1 = no satisfaction/improvement; 10 = fantastic satisfaction/improvement). The results ranged from 5 to 10 (mean 9). The same results were achieved regarding well-being.


CONCLUSIONS
The MACE is a successful management option in children with faecal incontinence or intractable constipation. Patients' stool pattern, quality of life and satisfaction are greatly improved. However, the method is not without problems.
Odense Universitetshospital, Kirurgisk Afdeling A, Odense C.
Susanne Morsing
SM
Krogsgaard
Mette Dia
MD
Milling
Niels
N
Qvist
D000293:Adolescent; D001065:Appendix / Q000601:surgery*; D002431:Cecostomy; D002648:Child; D002675:Child, Preschool; D003125:Colostomy; D003248:Constipation / Q000601:surgery*; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D012189:Retrospective Studies; D054047:Surgical Stomas / Q000009:adverse effects; D011795:Surveys and Questionnaires; D016896:Treatment Outcome