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Long-Term Functional Assessment of Antegrade Colonic Enema for Combined Incontinence and Constipation Using a Modified Marsh and Kiff Technique

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Diseases of the Colon & Rectum

Purpose

Constipation and fecal incontinence can severely affect quality of life for patients, particularly when simultaneously present. Malone antegrade colonic enema enables periodic colonic emptying, thus preventing uncontrolled passage of feces and constipation.

Methods

Eleven patients with fecal incontinence and severe constipation or perineal colostomy after Miles’ operation underwent a modified Marsh and Kiff ileostomy for antegrade colonic enema. Before and after surgery, the patients were fully evaluated for gastrointestinal functions, including gallbladder and stomach emptying time, H2-breath test, colonic transit time, dynamic defecography, and anorectal manometry. The severity of incontinence and constipation was scored preoperatively and postoperatively by using the American Medical System score and Cleveland Clinic Constipation scale, respectively, whereas the quality of life was measured by the Gastrointestinal Quality of Life Index. The surgical technique involved division of the terminal ileum 10 to 15 cm from the ileocecal valve, anastomosis and intussusception of the ileum with the cecum, narrowing of the ileal conduit with a linear stapler, and a small, introflexed ileostomy with an advanced skin flap.

Results

During the postoperative period, the mean American Medical System score decreased significantly from 77 to 11 (P < 0.01) and the mean Cleveland Clinic Constipation score from 23 to 8.5 (P < 0.01) with a significant improvement of quality of life. Antegrade colonic enema did not affect gallbladder, gastric, or orocecal transit time, which remained comparable with baseline. Colonic scintigraphy showed that antegrade colonic enema was efficient to clean the whole colon and rectum, leaving only 24 (range, 6–40) percent of the initial radioactivity after 30 minutes. Ileal manometry confirmed the presence of a high-pressure zone, preventing accidental reflux.

Conclusions

Modified Marsh and Kiff technique is a safe and effective surgical option to treat patients with combined fecal incontinence and severe constipation and those with perineal colostomy after Miles. It should be recommended as a last option before colostomy.

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Acknowledgment

The authors thank Mrs. Mary Victoria Pragnell for revising the manuscript and Dr. Francesco Arcanà for active contribution to the study.

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Authors and Affiliations

  1. Department of Emergency and Organ Transplantation, General Surgery and Liver Transplantation Unit, University of Bari, piazza G Cesare, 11–70124, Bari, Italy

    Donato F. Altomare M.D., Marcella Rinaldi M.D. & Vincenzo Memeo M.D.

  2. DiMIMP, Section of Nuclear Medicine, University of Bari, Bari, Italy

    Domenico Rubini M.D., Giuseppe Rubini M.D. & Niccoli-Asabella Artor M.D.

  3. Department of Internal Medicine and Public Medicine, University of Bari, Bari, Italy

    Piero Portincasa Ph.D. & Michele Vacca M.D.

  4. Department of Surgical Unit, Ospedale Moscati, Avellino, Italy

    Giovanni Romano M.D.

Authors
  1. Donato F. Altomare M.D.
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  2. Marcella Rinaldi M.D.
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  3. Domenico Rubini M.D.
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  4. Giuseppe Rubini M.D.
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  5. Piero Portincasa Ph.D.
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  6. Michele Vacca M.D.
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  7. Niccoli-Asabella Artor M.D.
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  8. Giovanni Romano M.D.
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  9. Vincenzo Memeo M.D.
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Correspondence to Donato F. Altomare M.D..

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Altomare, D.F., Rinaldi, M., Rubini, D. et al. Long-Term Functional Assessment of Antegrade Colonic Enema for Combined Incontinence and Constipation Using a Modified Marsh and Kiff Technique. Dis Colon Rectum 50, 1023–1031 (2007). https://doi.org/10.1007/s10350-006-0863-0

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  • DOI: https://doi.org/10.1007/s10350-006-0863-0

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