Cecal volvulus: a report of two cases occurring after the antegrade colonic enema procedure
Autor: | Richard C. Rink, E.R. Kokoska, C.D. Herndon, Karen W. West, D.E. Carney, Jay L. Grosfeld, M. Lerner |
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Rok vydání: | 2004 |
Předmět: |
Male
medicine.medical_specialty Abdominal pain Meningomyelocele medicine.medical_treatment Enema Peritonitis digestive system Anus Imperforate Ileostomy Postoperative Complications Stoma (medicine) Ileum Ischemia Laparotomy Intestinal Fistula medicine Cecal Diseases Humans Fecal incontinence Urinary Bladder Neurogenic Child Cecum Retrospective Studies business.industry General surgery General Medicine medicine.disease Combined Modality Therapy Respiration Artificial digestive system diseases Surgery Bowel obstruction Acute abdomen Chronic Disease Pediatrics Perinatology and Child Health Fluid Therapy medicine.symptom business Fecal Incontinence Intestinal Volvulus |
Zdroj: | Journal of Pediatric Surgery. 39:916-919 |
ISSN: | 0022-3468 |
Popis: | Background Many children with chronic constipation and fecal incontinence have benefited from the antegrade colonic enema (ACE) procedure. Routine antegrade colonic lavage often allows such children to avoid daytime soiling. This report describes 2 children in whom the ACE procedure was complicated by a cecal volvulus. Methods A retrospective review of 164 children with an ACE procedure was conducted. Two instances of cecal volvulus were identified. Results The first child presented with abdominal pain and difficulty intubating the ACE site. Over the subsequent day, his pain worsened, and radiographs depicted a colonic obstruction. At laparotomy, a cecal volvulus resulting in bowel necrosis was observed, and resection of the affected bowel and appendix (in the right lower quadrant) and end ileostomy was required. He subsequently had the stoma closed and a new ACE constructed with a colon flap. The second child presented with shock and evidence of an acute abdomen. At laparotomy, a cecal volvulus was noted, and ileocolic resection including the ACE stoma (located at the umbilicus) and an ileostomy and Hartmann pouch was performed. He had a protracted hospital course requiring ventilator and inotropic support. He currently is well and still has an ileostomy stoma. Conclusions A high index of suspicion for a potentially life-threatening cecal volvulus should be maintained in children undergoing an ACE procedure who present with abdominal pain, evidence of bowel obstruction, or difficulty in advancing the ACE irrigation catheter. |
Databáze: | OpenAIRE |
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