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
Background:Previous reports on percutaneous endoscopic cecostomy(PEC)for the delivery of antegrade continence enema(ACE)in adults have been presented in the form of case reports.Heretofore the tubes used in the pull m...Background:Previous reports on percutaneous endoscopic cecostomy(PEC)for the delivery of antegrade continence enema(ACE)in adults have been presented in the form of case reports.Heretofore the tubes used in the pull method of PEC have been thick bolster catheters.The author performed PEC by using the introducer method(IM)with 10 F Chait Trapdoor cecostomy catheters(CTCC)in adult cases.Objective:Report author experience with a new method of PEC in adults.Design:Case series.Setting:Single institution in Japan.Patients:Five patients with bowel obstruction and 15 patients with chronic severe constipation.Interventions:The interventions were the pull method or IM of PEC and drainage or ACE.In 5 cases,PEC was performed by the pull method with the use of an 18 F to 24 F bolster catheter for decompression of dilated intestine.In 15 patients with chronic constipation,PEC was performed with the IM method using a balloon catheter(11 F or 15 F)and CTCC.ACE was performed every other day.Results:PEC was successful and effective(decompression and evacuation)in all patients.In patients with IM of PEC,5 patients were placed with a 15 F balloon catheter and 10 patients were placed with an 11 F balloon catheter.Immediate bleeding occurred in 1 case.Balloon rupture occurred during the first month or on average at the 1 month period.Nine of 10 patients who had the 11 F catheters were changed to CTCC.The advantages of CTCC were prevention of accidental balloon rapture,decreased leakage and granulation tissue,and ease of exchange compared with bolster catheter.Limitations:Retrospective,single-institution.Conclusions:PEC with IM is a safe and useful method.CTCC is advantageous on a long-term basis for ACE.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Background:Previous reports on percutaneous endoscopic cecostomy(PEC)for the delivery of antegrade continence enema(ACE)in adults have been presented in the form of case reports.Heretofore the tubes used in the pull method of PEC have been thick bolster catheters.The author performed PEC by using the introducer method(IM)with 10 F Chait Trapdoor cecostomy catheters(CTCC)in adult cases.Objective:Report author experience with a new method of PEC in adults.Design:Case series.Setting:Single institution in Japan.Patients:Five patients with bowel obstruction and 15 patients with chronic severe constipation.Interventions:The interventions were the pull method or IM of PEC and drainage or ACE.In 5 cases,PEC was performed by the pull method with the use of an 18 F to 24 F bolster catheter for decompression of dilated intestine.In 15 patients with chronic constipation,PEC was performed with the IM method using a balloon catheter(11 F or 15 F)and CTCC.ACE was performed every other day.Results:PEC was successful and effective(decompression and evacuation)in all patients.In patients with IM of PEC,5 patients were placed with a 15 F balloon catheter and 10 patients were placed with an 11 F balloon catheter.Immediate bleeding occurred in 1 case.Balloon rupture occurred during the first month or on average at the 1 month period.Nine of 10 patients who had the 11 F catheters were changed to CTCC.The advantages of CTCC were prevention of accidental balloon rapture,decreased leakage and granulation tissue,and ease of exchange compared with bolster catheter.Limitations:Retrospective,single-institution.Conclusions:PEC with IM is a safe and useful method.CTCC is advantageous on a long-term basis for ACE.
