Appendicostomy in the treatment of severe defecation disorders in children
Krogsgaard, S.M.; Milling, M.D.; Qvist, N.
Ugeskrift for Laeger 168(7): 692-694
2006
ISSN/ISBN: 1603-6824 PMID: 16494809 Document Number: 597446
The Malone antegrad colonic enema (MACE) has been an option in the treatment of children with severe faecal incontinence or intractable constipation at Odense University Hospital. We did a retrospective review of 32 case records and questionnaires completed by the patients. Pre-existing conditions included anorectal anomaly, myelomeningocele, Hirschsprung's disease and idiopathic constipation. The mean age at operation was 8.7 years (range 4-16 years), and the mean follow-up time was 2.5 years (range 1-8 years). Of the 32 patients, 31 returned the questionnaire. Three children had obtained satisfactory colonic function, and 2 patients had had a colostomy because of an unsatisfactory result. Of the remaining 26 patients, all reported improvement and 46% were completely clean. Complications related to the stoma included stomal stenosis (41%) and stomal leakage (62%), and 54% had experienced some degree of abdominal pain during the procedure. The patients' satisfaction with the MACE procedure and their improvement in general well-being was evaluated on a scale from 1 to 10 (1 = no satisfaction/improvement; 10 = fantastic satisfaction/improvement). The results ranged from 5 to 10 (mean 9). The same results were achieved regarding well-being. The MACE is a successful management option in children with faecal incontinence or intractable constipation. Patients' stool pattern, quality of life and satisfaction are greatly improved. However, the method is not without problems.