Hydrocolonic sonography: a helpful diagnostic tool to implement effective bowel management

Abstract

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.

Improvements in Incontinence with Self-Management in Patients with Anorectal Malformations

“…We used hydrosonography to assess the amount of fluid needed to effectively clean the colon from the anal canal to the cecum. 8 Sonography was performed after colonic preparation and was also useful for the detection of incomplete stool evacuation. The lack of radiation exposure makes hydrocolonic sonography a useful option for the assessment and follow-up of therapeutic efforts of incontinence both in pediatric and older patients.…”

“…7 Then the bowel management was initiated with the help of hydrosonography to evaluate bowel motility and determine the volume of the enema. 8 Hydrocolonic sonography was done using NaCl 0.9% as contrast medium. To avoid leakage, a Foley catheter with an inflated balloon and traction was inserted into the anal canal.…”

Consensus Review of Best Practice of Transanal Irrigation in Children

“…This calculation should be based on ideal body weight for height rather than the actual weight of an obese child. In selected or nonresponding patients, a more individualized approach can be considered, which may include information from imaging studies (6,31).…”

Quantification and Monitoring of Inflammation in Murine Inflammatory Bowel Disease with Targeted Contrast-enhanced US

“…Furthermore, recent technical improvements in clinical US imaging of the bowel wall that have resulted from the introduction of hydrosonography have overcome possible limitations of US caused by gas in the bowel lumen ( 17,18 ). Thus, the purpose of our study was to evaluate US imaging by using contrast agent MBs targeted to P-selectin (MB P-selectin ) to quantify P-selectin expression levels in infl amed tissue and to monitor response to therapy in a murine model of chemically induced IBD.…”