Ten-year experience using antegrade enemas in children.
OBJECTIVE
To describe a single-center, 10-year experience with the use of antegrade enemas.


METHODS
Retrospective analysis of 99 patients treated with antegrade enemas at Nationwide Children's Hospital.


RESULTS
Study subjects (median age 8 years) were followed for a mean time of 46 months (range 2-125 months) after cecostomy placement. Seventy-one patients had the cecostomy placed percutaneously and 28 by surgery. Thirty-five patients had functional constipation and 64 patients an organic disease (spinal abnormalities, cerebral palsy, imperforate anus, Hirschsprung's disease). While using antegrade enemas, 71% became symptom-free, in 20 subjects symptoms improved, in 2 subjects symptoms did not change, and in 7 subjects symptoms worsened. Poor outcome was associated with surgical placement of the cecostomy (P < .001), younger age (P = .02), shorter duration of symptoms (P = .01), history of Hirschsprung's disease (P = .05), cerebral palsy (P = .03), previous abdominal surgery (P = .001), and abnormal colonic manometry (P = .004). In 88%, successful irrigation solution included use of a stimulant laxative, and subjects who used a stimulant did significantly better (P < .001) than subjects who started without a stimulant. In 13 patients, the cecostomy was removed 49.7 months after placement without recurrence of symptoms. Major complications occurred in 12 patients and minor complications in 47.


CONCLUSIONS
Antegrade enemas represent a successful and relatively safe therapeutic option in children with severe defecatory disorders. Prognostic factors are identified.
Division of Gastroenterology, Nationwide Children's Hospital, Columbus, OH, USA. s.m.mugie@amc.nl
Suzanne M
SM
Mugie
Rodrigo S
RS
Machado
Hayat M
HM
Mousa
Jaya B
JB
Punati
Mark
M
Hogan
Marc A
MA
Benninga
Carlo
C
Di Lorenzo
D000293:Adolescent; D002431:Cecostomy; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000209:etiology / Q000628:therapy*; D004733:Enema / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D055815:Young Adult