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Characteristics of the Contrast Enema Do Not Predict an Effective Bowel Management Regimen for Patients with Constipation or Fecal Incontinence

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ABSTRACT

Background: A bowel management program using large volume enemas may be required for children with anorectal malformations (ARM), Hirschsprung’s disease (HD), severe medically refractive idiopathic constipation (IC), and other conditions. A pretreatment contrast enema is often obtained. We sought to determine if the contrast enema findings could predict a final enema regimen.

Methods: A retrospective review was performed at a tertiary care children’s hospital from 2011 to 2014 to identify patients treated with enemas in our bowel management program. Patient characteristics, contrast enema findings (including volume to completely fill the colon), and final enema regimen were collected.

Results: Eighty-three patients were identified (37 ARM, 7 HD, 34 IC, and 5 other). Age ranged from 10 months to 24 years, and weight ranged from 6.21 kg to 95.6 kg at the time bowel management was initiated. Linear regression showed contrast enema volume was of limited value in predicting effective therapeutic saline enema volume (R2 = 0.21). The addition of diagnosis, colon dilation, and contrast retention on plain x-ray the day after the contrast enema moderately improved the predictive ability of the contrast enema (R2 = 0.35). Median final effective enema volume was 22 mL/kg (range: 5 - 48 mL/kg).

Conclusions: We were unable to demonstrate a correlation with contrast enema findings and the effective enema volume. However, no patient required a daily enema volume greater than 48 mL/kg to stay clean.

No MeSH data available.


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Contrast Enema FindingsA = normal caliber, non-dilated colon; B = global dilation; C = rectosigmoid dilation; D = rectal dilation. 
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FIG1: Contrast Enema FindingsA = normal caliber, non-dilated colon; B = global dilation; C = rectosigmoid dilation; D = rectal dilation. 

Mentions: A retrospective review was conducted at our tertiary care children’s hospital from 2011 to 2014 with IRB approval from the University of Utah, approval #74392. Waiver of consent was obtained from IRB for this retrospective review. Children enrolled in the bowel management program at our colorectal center were identified. Patients managed with enemas were selected for further review. Large-volume saline enemas were selected on an individual basis to manage medically refractive constipation, fecal incontinence, and pseudo-incontinence. Patient characteristics included diagnosis, age, and weight at initiation of bowel management. Radiographic observations included colonic motility, which was inferred from retained contrast on follow-up x-ray the day after the contrast enema, redundancy and dilation of the colon, and contrast volume required to fill the entire colon during the study. The colon was characterized as non-dilated, dilated rectum, rectosigmoid dilation, or global dilation (Figure 1). For analysis, patients with rectal dilation were combined with the rectosigmoid dilation group. Treatment was successful if the abdominal radiograph was clear of stool in the rectum and left colon, and the child had no soiling within one week of starting the bowel management program. Complete records, including the final enema regimen with appropriate follow-up, were available for 94 patients.


Characteristics of the Contrast Enema Do Not Predict an Effective Bowel Management Regimen for Patients with Constipation or Fecal Incontinence
Contrast Enema FindingsA = normal caliber, non-dilated colon; B = global dilation; C = rectosigmoid dilation; D = rectal dilation. 
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036987&req=5

FIG1: Contrast Enema FindingsA = normal caliber, non-dilated colon; B = global dilation; C = rectosigmoid dilation; D = rectal dilation. 
Mentions: A retrospective review was conducted at our tertiary care children’s hospital from 2011 to 2014 with IRB approval from the University of Utah, approval #74392. Waiver of consent was obtained from IRB for this retrospective review. Children enrolled in the bowel management program at our colorectal center were identified. Patients managed with enemas were selected for further review. Large-volume saline enemas were selected on an individual basis to manage medically refractive constipation, fecal incontinence, and pseudo-incontinence. Patient characteristics included diagnosis, age, and weight at initiation of bowel management. Radiographic observations included colonic motility, which was inferred from retained contrast on follow-up x-ray the day after the contrast enema, redundancy and dilation of the colon, and contrast volume required to fill the entire colon during the study. The colon was characterized as non-dilated, dilated rectum, rectosigmoid dilation, or global dilation (Figure 1). For analysis, patients with rectal dilation were combined with the rectosigmoid dilation group. Treatment was successful if the abdominal radiograph was clear of stool in the rectum and left colon, and the child had no soiling within one week of starting the bowel management program. Complete records, including the final enema regimen with appropriate follow-up, were available for 94 patients.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: A bowel management program using large volume enemas may be required for children with anorectal malformations (ARM), Hirschsprung’s disease (HD), severe medically refractive idiopathic constipation (IC), and other conditions. A pretreatment contrast enema is often obtained. We sought to determine if the contrast enema findings could predict a final enema regimen.

Methods: A retrospective review was performed at a tertiary care children’s hospital from 2011 to 2014 to identify patients treated with enemas in our bowel management program. Patient characteristics, contrast enema findings (including volume to completely fill the colon), and final enema regimen were collected.

Results: Eighty-three patients were identified (37 ARM, 7 HD, 34 IC, and 5 other). Age ranged from 10 months to 24 years, and weight ranged from 6.21 kg to 95.6 kg at the time bowel management was initiated. Linear regression showed contrast enema volume was of limited value in predicting effective therapeutic saline enema volume (R2 = 0.21). The addition of diagnosis, colon dilation, and contrast retention on plain x-ray the day after the contrast enema moderately improved the predictive ability of the contrast enema (R2 = 0.35). Median final effective enema volume was 22 mL/kg (range: 5 - 48 mL/kg).

Conclusions: We were unable to demonstrate a correlation with contrast enema findings and the effective enema volume. However, no patient required a daily enema volume greater than 48 mL/kg to stay clean.

No MeSH data available.


Related in: MedlinePlus