Cecostomy in Children with Defecation Disorders

Abstract

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.

Percutaneous cecostomy in the management of organic fecal incontinence in children

“…In this study, the primary and secondary technical success rates of insertion of cecostomy tubes were 95% and 100%, respectively, which are similar to other studies [8][9][10][11]14,15,17] . Long term follow up of patients showed resolution of continuous soiling in all patients with neurogenic fecal incontinence.…”

“…Traditional treatment options for fecal incontinence include dietary modification, drugs, retrograde enemas, manual disimpaction, biofeedback, electrostimulation and cognitive and behavioral interventions that facilitate continence. These options work well in controlling functional fecal incontinence [3,15,16] . However, these options are ineffective in controlling organic fecal incontinence, which may benefit from techniques that completely cleanse the colon and decrease the chance of soiling such as with percutaneous cecostomy.…”

Current Treatment of Childhood Constipation

“…A continent appendicostomy or a button cecostomy can be created to provide anterograde administration of enemas aimed at cleansing the entire colon and providing predictable fecal incontinence-free intervals. Cecostomy tubes can be safely placed percutaneously by interventional radiology or endoscopy instead of surgery [43] . Regular colonic lavage results in a significant increase in defecation frequency, a reduction in fecal incontinence frequency, and consequently an improvement in quality of life [43,44] .…”

“…Cecostomy tubes can be safely placed percutaneously by interventional radiology or endoscopy instead of surgery [43] . Regular colonic lavage results in a significant increase in defecation frequency, a reduction in fecal incontinence frequency, and consequently an improvement in quality of life [43,44] . Success rates are high in most studies (up to 80%), probably due to careful pre-cecostomy evaluation and patient selection.…”

“…Potential side effects in children receiving an appendicostomy are stenosis of the cutaneous opening (11%), painful or difficult catheterization (5%), and iatrogenic perforation of the appendicostomy [46] . Dislodged tubes (26%), leakage around the cecostomy button (42%), and granulation tissue (68%) are complications known to occur with cecostomy devices [43] .…”