Percutaneous Endoscopic Cecostomy for Antegrade Colonic Irrigation in Fecally Incontinent Children

Introduction

Fecal incontinence represents a severe and often underrated disability which affects many children with congenital anomalies such as anorectal malformations and spina bifida or, less frequently, patients who have previously undergone operation for Hirschsprung's disease. Spinal cord injury can also produce this socially unpleasant handicap.

Daily use of large-volume enemas is required in many patients to obtain adequate bowel emptying and to reduce the risk of embarrassing fecal soiling. This tedious and uncomfortable procedure is very often the cause of progressive disaffection, especially in teenagers, which leads to refusal of the enemas although these represent the only way of achieving satisfactory fecal control.

In 1990 Malone et al. described the antegrade continence enema (ACE) procedure. The latter has greatly improved the quality of life of many patients with fecal incontinence [1], but it has a high complication rate. Shandling et al. proposed a radiologically guided technique of percutaneous cecostomy for ACE, reporting a very low incidence of complications [2].

In this paper we describe a new technique of percutaneous endoscopic cecostomy (PEC), carried out in three children with fecal incontinence.

References

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