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Medline ® Abstract for Reference 121

of 'Chronic functional constipation and fecal incontinence in infants and children: Treatment'

Ten-year experience using antegrade enemas in children.
Mugie SM, Machado RS, Mousa HM, Punati JB, Hogan M, Benninga MA, Di Lorenzo C
J Pediatr. 2012 Oct;161(4):700-4. Epub 2012 Jun 9.
OBJECTIVE: To describe a single-center, 10-year experience with the use of antegrade enemas.
STUDY DESIGN: 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; Division of Gastroenterology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: s.m.mugie@amc.nl.