ANTEGRADE CONTINENCE ENEMAS IN THE MANAGEMENT OF INTRACTABLE FECAL INCONTINENCE

The introduction of the Malone procedure has improved the outlook for children with severe faecal incontinence. Phosphate and saline enemas are administered through the exteriorized appendix in antegrade fashio n to achieve evacuation and ensure cleanliness. The appendix functions as a non-refluxing catheterizable channel: If it is not available for use, a tubularized caecal flap is a safe alternative. We have constru cted Malone stomas using the appendix in 20 patients and another seven patients have undergone the caecal flap modification. The mean age wa s 8.6 years. Eleven of the patients were boys and 16 (59%) were girls. Six children required dilatation or revision of their stomas for sten osis. One developed small bowel obstruction and another has stopped us ing the stoma. The results of the continence enemas were considered to be very good by the vast majority of patients and their carers. Our r ecent experience suggests that bisacodyl may be a valuable adjunct to the antegrade enemas of phosphate and saline. We believe that this pro cedure may be extended with benefit to adults with serious faecal inco ntinence in wham standard measures have failed.