Hydrocolonic sonography: a helpful diagnostic tool to implement effective bowel management.
Fecal incontinence is a serious problem that may lead to social segregation and psychological problems. Patients with anorectal malformations frequently suffer from fecal incontinence even with an excellent anatomic repair. In these patients, an effective management program with enemas can improve their quality of life. We want to present our experience with hydrocolonic sonography as a diagnostic tool to predict the type and volume of enema needed to initiate an effective bowel management. Patients who presented with soiling regardless of the type of anomaly were included in the study. Thirty patients aged 4-18 were evaluated. The diagnostic program comprised a careful clinical history, physical examination, exact classification of the malformation, evaluation for associated defects, and stool protocol. Twenty patients suffered from true fecal incontinence and were included in a bowel management program. These patients received oral polyethyleneglycol to evacuate stool impaction. Bowel management was initiated with the help of hydrosonography to evaluate bowel motility. The volume of the enema was determined according to the amount of fluid that was needed to fill the colon to the cecum. Twenty patients were investigated with the help of hydrocolonic sonography. Eighteen patients were free of symptoms of soiling after 3 days of hospital treatment and remained free of symptoms 6 months and 1 year later at reevaluation. Two patients did not follow the therapeutic regime and, therefore, did not show an improved condition concerning soiling in the long run. Hydrocolonic sonography is a helpful diagnostic tool to assess colonic volume and motility to predict the type and volume of enema needed for an effective bowel management.
Märzheuser
S
S
Department of Pediatric Surgery, Charité University Hospital Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany. stefanie.maerzheuser@charite.de
Schmidt
D
D
David
S
S
Rothe
K
K
D000293:Adolescent; D002648:Child; D003106:Colon / Q000000981:diagnostic imaging*; D004733:Enema; D005242:Fecal Incontinence / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D014463:Ultrasonography
J Clin Ultrasound. 1978 Feb;6(1):28-33
416043
Curr Probl Surg. 2002 Jul;39(7):666-730
12085018
Acta Chir Belg. 1983 May-Jun;82(3):191-204
6880529
Semin Pediatr Surg. 1995 Feb;4(1):35-47
7728507
Curr Opin Pediatr. 2005 Jun;17(3):394-401
15891433
J Pediatr Surg. 2005 Oct;40(10):1521-6
16226976
J Pediatr Surg. 1992 Jul;27(7):902-5
1640341
World J Pediatr. 2008 Aug;4(3):206-10
18822930
Eur J Pediatr Surg. 2001 Oct;11(5):305-10
11719867
Zentralbl Chir. 1990;115(22):1409-22
2291345
J Pediatr Surg. 2001 Sep;36(9):1350-6
11528604
J Pediatr Surg. 1994 Jun;29(6):777-80
8078019
J Pediatr Surg. 1998 Jan;33(1):133-7
9473119
J Clin Gastroenterol. 1987 Oct;9(5):607-11
3316375