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Neurogastroenterology and Motility Oct 2023Children with constipation and encopresis are often treated with medication and behavioral approaches. When constipation persists, surgical interventions such as... (Review)
Review
BACKGROUND
Children with constipation and encopresis are often treated with medication and behavioral approaches. When constipation persists, surgical interventions such as antegrade continence enema (ACE) procedures are considered. Many children benefit from these procedures; however, some children continue to have incontinence, experience complications, or discontinue the use of the ACE stoma. There is some evidence in the literature to indicate that psychosocial factors can have an impact on ACE outcomes; however, standardized biopsychosocial guidelines related to ACE candidacy and surgery do not currently exist.
PURPOSE
The purpose of this review is to summarize the research to date on psychosocial factors related to ACE treatment outcomes and complications. Identifying what is known and what limitations remain can support future research to inform development of guidelines for pre-procedure evaluations. Psychosocial pre-procedure evaluations could help to inform eligibility for the procedure as well as interventions to enhance outcomes for children at increased risk for poor outcomes or complications from ACE. Age, psychiatric symptoms, and adherence to the ACE flush regimen were some of the factors identified in the literature as impacting ACE outcomes; however, there is limited research in this area.
Topics: Child; Humans; Fecal Incontinence; Treatment Outcome; Enema; Constipation; Retrospective Studies
PubMed: 37427680
DOI: 10.1111/nmo.14644 -
The American Journal of Gastroenterology Aug 2001
Topics: Enema; History, 15th Century; History, 16th Century; History, 19th Century; History, Ancient; Humans
PubMed: 11513195
DOI: 10.1111/j.1572-0241.2001.04057.x -
The American Journal of Gastroenterology Sep 2002
Topics: Constipation; Enema; History, 18th Century; Humans; Nicotiana
PubMed: 12358271
DOI: 10.1111/j.1572-0241.2002.06001.x -
The Journal of Surgical Research Jul 2022Ileocolic intussusception is a common cause of pediatric bowel obstruction. Contrast enema is successful in treating the majority of patients, and if initially...
INTRODUCTION
Ileocolic intussusception is a common cause of pediatric bowel obstruction. Contrast enema is successful in treating the majority of patients, and if initially unsuccessful, approximately one-third may be reduced with repeat enemas. We sought to study protocol implementation for delayed repeat enema in pediatric patients not reduced completely by an initial contrast enema. Our aims were to assess repeat enema success rates and outcome differences in preprotocol and postprotocol patients with respect to (1) intussusception recurrence, (2) surgical intervention and complication rates, and (3) length of stay.
MATERIALS AND METHODS
We performed a retrospective review of treatment and clinical outcomes prior to and following protocol implementation for repeat enema for intussusception at two tertiary pediatric referral hospitals. The preprotocol period was defined from 2/2013 to 2/2016, and the postprotocol period was from 8/2016 to 11/2019.
RESULTS
There were 112 patients in the preprotocol group, with 74 (66%) having successful reduction following the first enema. Of the 38 patients without successful reduction, 16 (42%) patients underwent repeat enema, and five were successful (31%). The postprotocol group included 122 patients, with 84 (69%) having successful first reduction. Of the 38 patients that failed, 25 patients (66%) underwent repeat enema, of which 13 (52%) were successful. Compared to preprotocol patients, postprotocol patients had significantly more enemas repeated and a trend toward fewer surgical interventions.
CONCLUSIONS
Protocol implementation of repeat delayed enemas was significantly associated with an increased rate of repeat enemas at our institutions and reduced need for operative intervention during the index stay.
Topics: Child; Enema; Humans; Ileal Diseases; Infant; Intussusception; Retrospective Studies; Treatment Outcome
PubMed: 35259668
DOI: 10.1016/j.jss.2022.01.008 -
American Journal of Proctology Aug 1958
Topics: Animals; Coleoptera; Enema; Humans; Intestines; Toxoplasma
PubMed: 13559500
DOI: No ID Found -
Journal of Pediatric Surgery Aug 2022Children with severe constipation and a neurodiverse disorder (Autism and/or developmental delay) represent a challenging bowel management group. Treatment outcomes with... (Review)
Review
The presence of a neurodiverse disorder is associated with increased use of antegrade enema therapy in children with severe constipation: A study from the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC).
INTRODUCTION
Children with severe constipation and a neurodiverse disorder (Autism and/or developmental delay) represent a challenging bowel management group. Treatment outcomes with laxative or enema therapy remain limited and are often complicated by patient/caregiver compliance. We hypothesized that children with neurodiverse disorders and severe constipation would benefit from a bowel management program (BMP) that includes early use of antegrade enemas.
MATERIALS AND METHODS
Children requiring BMP in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) registry with diagnosis of constipation and/or constipation with pseudo-incontinence were reviewed. Those with Hirschsprung disease and/or Anorectal Malformation were excluded. BMP needs in patients with a neurodiverse diagnosis were compared to those without to evaluate differences in BMP's.
RESULTS
372 patients requiring a BMP were identified. 95 patients (58 autism spectrum, 54 developmental delay) were neurodiverse, and 277 patients were not. Neurodiverse patients had a higher prevalence of enema therapy 62.1% (59/95) vs. 54.9% (152/273) and use of antegrade enema therapy 33.7% (32/95) vs. 21.2% (58/273), p = 0.126. Neurodiverse patients were older 37.9% (36/95) > 12 years vs. 23.1% (63/273), p = 0.001 and 47.6% (10/21) were changed from laxative to enema therapy over time. 80% (8/10) of those changed from laxatives to enemas used antegrade therapy. 67.3% (35/52) of neurodiverse patients followed over time were on enema therapy at the most recent visit with 80% (28/35) requiring antegrade therapy.
CONCLUSION
A large portion of patients with a neurodiverse disorder who fail laxative therapy use antegrade enemas to achieve effective bowel management. Early consideration of an antegrade conduit may simplify treatment in this group of children.
LEVEL OF EVIDENCE
III.
Topics: Child; Colorectal Neoplasms; Constipation; Enema; Fecal Incontinence; Humans; Laxatives; Retrospective Studies; Treatment Outcome
PubMed: 35597676
DOI: 10.1016/j.jpedsurg.2022.04.008 -
Nursing Standard (Royal College of... Dec 2015Rationale and key points This article aims to help nurses to undertake the administration of enemas in a safe, effective and patient-centred manner, ensuring privacy and...
Rationale and key points This article aims to help nurses to undertake the administration of enemas in a safe, effective and patient-centred manner, ensuring privacy and dignity. The administration of an enema is a common healthcare procedure, which can be used to deliver medication or aid bowel evacuation. ▶ The administration of an enema should be undertaken by a competent nurse. ▶ An enema is a liquid preparation inserted into the rectum. ▶ The nurse must explain the procedure to the patient and should assist the individual before, during and after the procedure. ▶ The nurse should document all care given. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How you felt performing this intimate procedure. 2. The positive elements of care delivery and those that could be enhanced. Subscribers can upload their reflective accounts at: rcni.com/portfolio .
Topics: Clinical Competence; Enema; Humans; Rectum; United Kingdom
PubMed: 26639291
DOI: 10.7748/ns.30.14.34.s43 -
The Medical Journal of Australia Mar 1994To report a case of hypocalcaemic tetany occurring in a child secondary to two phosphate enemas administered for faecal retention, and review the literature of phosphate... (Review)
Review
OBJECTIVE
To report a case of hypocalcaemic tetany occurring in a child secondary to two phosphate enemas administered for faecal retention, and review the literature of phosphate enema toxicity in children.
CLINICAL FEATURES
A 23-month-old child with a repaired anorectal malformation and associated unilateral renal hypodysplasia presented with hypocalcaemic tetany (minimum serum calcium level, 1.11 mmol/L), hyperphosphataemia (maximum serum phosphate level, 6.06 mmol/L), hypokalaemia (minimum serum potassium level, 1.9 mmol/L) and dehydration 10 hours after the administration of two phosphate enemas for acute on chronic faecal retention. MANAGEMENT AND OUTCOME: Management consisted of parenteral rehydration, potassium supplementation, calcium gluconate, an enterally administered phosphate binder and saline bowel washouts to evacuate the remaining enema. She was discharged on day eight, with normal biochemical parameters and no neurological sequelae.
CONCLUSION
The use of phosphate enemas in children under five years of age is associated with significant morbidity due to hyperphosphataemia, hypocalcaemia, hypokalaemia and dehydration. They should not be used in children under two years of age, and should be used only with extreme caution in children aged two to five years, especially in those with underlying bowel or renal dysfunction.
Topics: Child; Child, Preschool; Enema; Female; Humans; Hypertonic Solutions; Hypocalcemia; Infant; Phosphates; Tetany
PubMed: 8133819
DOI: No ID Found -
Nursing Times
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Journal of Pediatric Surgery Aug 2005There are references in the medical literature that Henoch-Schönle purpura (HSP) and abdominal pain are contraindictions to performing contrast enemas (CEs) for... (Review)
Review
BACKGROUND/PURPOSE
There are references in the medical literature that Henoch-Schönle purpura (HSP) and abdominal pain are contraindictions to performing contrast enemas (CEs) for diagnosis and possible reduction of intussusceptions. We investigated the safety of performing CEs in patients with abdominal pain and HSP.
METHODS
A retrospective chart review and literature search were conducted.
RESULTS
CEs were not associated with complications in patients with HSP and abdominal pain and intussusceptions.
CONCLUSIONS
CEs are safe to perform in patients with HSP and suspected intussusceptions and may be useful for diagnosis and treatment.
Topics: Abdomen, Acute; Barium Sulfate; Child, Preschool; Contraindications; Enema; Humans; IgA Vasculitis; Intussusception; Radiography; Retrospective Studies; Ultrasonography
PubMed: 16080921
DOI: 10.1016/j.jpedsurg.2005.05.001