Antegrade continence enemas in the treatment of slow-transit constipation

Background/Purpose: Children with anorectal dysfunction can now be treated by antegrade continence enema (ACE), as described Malone et al. Those with idiopathic constipation, however, are not thought to be suitable for this t reatment. Over 150 children attend the authors' department with proven slow transit constipation (mostly proven on nuclear transit/X-ray study), and t he authors reviewed the outcome in the 40 of these who have had the ACE pro cedure. Families completed a questionnaire and attended interview with an i ndependent assessor. Methods: Of the 40 patients, 32 patients were assessed. Follow-up ranged fr om 3 to 54 months (median, 18 months) and age ranged from 5 to 17 years (me dian age, 10 years). Three of 32 stomas were no longer in use. Frequency of soiling was reduced significantly in 20 patients, and a further 6 patients were clean (P < .01). Abdominal pains were relieved significantly (P < .05 ), and appetite and mood improved. Results: Stomal complications were frequent, (stenosis in 16 of 29, mucus l eak in 20 of 29, fecal leak 3 of 29, catheter-related pain in 20 of 29). Sl ow evacuation (12 of 29) and pain with enema (17 of 20) also were common. Conclusion: Malone appendicostomy does improve the well being of patients w ith slow transit constipation, but the advantages are less dramatic than in children with normal motility. J Pediatr Surg 36:1227-1230. Copyright (C) 2001 by W.B. Saunders Company.