Purpose:The aim of this study was to define the predictive value of colonic manometry and contrast enema before cecostomy placement in children with defecation disorders. Methods:Medical records,contrast enema,and col...Purpose:The aim of this study was to define the predictive value of colonic manometry and contrast enema before cecostomy placement in children with defecation disorders. Methods:Medical records,contrast enema,and colonic manometry studies were reviewed for 32 children with defecation disorders who underwent cecostomy placement between 1999 and 2004. Diagnoses included idiopathic constipation (n=13),Hirschsprung’s disease (n=2),cerebral palsy (n=1),imperforate anus (n=6),spinal abnormality (n=6),and anal with spinal abnormality (n =4). Contrast enemas were evaluated for the presence of anatomic abnormalities and the degree of colonic dilatation. Colonic manometry was considered normal when high-amplitude propagating contractions (HAPC) occurred from proximal to distal colon. Clinical success was defined as normal defecation frequency with no or occasional fecal incontinence. Results:Colonic manometry was done on 32 and contrast enema on 24 patients before cecostomy. At follow-up,25 patients (78% ) fulfilled the success criteria. Absence of HAPC throughout the colon was related to unsuccessful outcome (P=0.03). Colonic response with normal HAPC after bisacodyl administration was predictive of success (P=0.03). Presence of colonic dilatation was not associated with colonic dysmotility. Conclusion:Colonic manometry is helpful in predicting the outcome after cecostomy. Patients with generalized colonic dysmotility are less likely to benefit from use of antegrade enemas via cecostomy. Normal colonic response to bisacodyl predicts favorable outcome.展开更多
Administration of antegrade enemas through a cecostomy is a therapeutic option for children with severe defecation disorders. The purpose of this study is to report our 4 year experience with the cecostomy procedure i...Administration of antegrade enemas through a cecostomy is a therapeutic option for children with severe defecation disorders. The purpose of this study is to report our 4 year experience with the cecostomy procedure in 31 children with functional constipation (n = 9), Hirschsprung’ s disease (n = 2), imperforate anus (n = 5), spinal abnormalities (n = 8), and imperforate anus in combination with tethered spinal cord (n = 7). Data regarding complications, antegrade enemas used, symptoms, and quality of life were retrospectively obtained. Placement of cecostomy tubes was successful in 30 of 31 patients. Soiling episodes decreased significantly in children with functional constipation (P = 0.01), imperforate anus (P < 0.01), and spinal abnormalities (P = 0.04). Quality of life improved in patients with functional constipation and imperforate anus. No difference in complications was found between percutaneous and surgical placement. Use of antegrade enemas via cecostomy improved symptoms and quality of life in children with a variety of defecation disorders.展开更多
文摘Purpose:The aim of this study was to define the predictive value of colonic manometry and contrast enema before cecostomy placement in children with defecation disorders. Methods:Medical records,contrast enema,and colonic manometry studies were reviewed for 32 children with defecation disorders who underwent cecostomy placement between 1999 and 2004. Diagnoses included idiopathic constipation (n=13),Hirschsprung’s disease (n=2),cerebral palsy (n=1),imperforate anus (n=6),spinal abnormality (n=6),and anal with spinal abnormality (n =4). Contrast enemas were evaluated for the presence of anatomic abnormalities and the degree of colonic dilatation. Colonic manometry was considered normal when high-amplitude propagating contractions (HAPC) occurred from proximal to distal colon. Clinical success was defined as normal defecation frequency with no or occasional fecal incontinence. Results:Colonic manometry was done on 32 and contrast enema on 24 patients before cecostomy. At follow-up,25 patients (78% ) fulfilled the success criteria. Absence of HAPC throughout the colon was related to unsuccessful outcome (P=0.03). Colonic response with normal HAPC after bisacodyl administration was predictive of success (P=0.03). Presence of colonic dilatation was not associated with colonic dysmotility. Conclusion:Colonic manometry is helpful in predicting the outcome after cecostomy. Patients with generalized colonic dysmotility are less likely to benefit from use of antegrade enemas via cecostomy. Normal colonic response to bisacodyl predicts favorable outcome.
文摘Administration of antegrade enemas through a cecostomy is a therapeutic option for children with severe defecation disorders. The purpose of this study is to report our 4 year experience with the cecostomy procedure in 31 children with functional constipation (n = 9), Hirschsprung’ s disease (n = 2), imperforate anus (n = 5), spinal abnormalities (n = 8), and imperforate anus in combination with tethered spinal cord (n = 7). Data regarding complications, antegrade enemas used, symptoms, and quality of life were retrospectively obtained. Placement of cecostomy tubes was successful in 30 of 31 patients. Soiling episodes decreased significantly in children with functional constipation (P = 0.01), imperforate anus (P < 0.01), and spinal abnormalities (P = 0.04). Quality of life improved in patients with functional constipation and imperforate anus. No difference in complications was found between percutaneous and surgical placement. Use of antegrade enemas via cecostomy improved symptoms and quality of life in children with a variety of defecation disorders.
