Ten-year experience using antegrade enemas in children

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.