Advertisement

Pediatric Surgery International

, Volume 26, Issue 11, pp 1121–1124 | Cite as

Hydrocolonic sonography: a helpful diagnostic tool to implement effective bowel management

  • S. Märzheuser
  • D. Schmidt
  • S. David
  • K. Rothe
Original Article

Abstract

Fecal incontinence is a serious problem that may lead to social segregation and psychological problems. Patients with anorectal malformations frequently suffer from fecal incontinence even with an excellent anatomic repair. In these patients, an effective management program with enemas can improve their quality of life. We want to present our experience with hydrocolonic sonography as a diagnostic tool to predict the type and volume of enema needed to initiate an effective bowel management. Patients who presented with soiling regardless of the type of anomaly were included in the study. Thirty patients aged 4–18 were evaluated. The diagnostic program comprised a careful clinical history, physical examination, exact classification of the malformation, evaluation for associated defects, and stool protocol. Twenty patients suffered from true fecal incontinence and were included in a bowel management program. These patients received oral polyethyleneglycol to evacuate stool impaction. Bowel management was initiated with the help of hydrosonography to evaluate bowel motility. The volume of the enema was determined according to the amount of fluid that was needed to fill the colon to the cecum. Twenty patients were investigated with the help of hydrocolonic sonography. Eighteen patients were free of symptoms of soiling after 3 days of hospital treatment and remained free of symptoms 6 months and 1 year later at reevaluation. Two patients did not follow the therapeutic regime and, therefore, did not show an improved condition concerning soiling in the long run. Hydrocolonic sonography is a helpful diagnostic tool to assess colonic volume and motility to predict the type and volume of enema needed for an effective bowel management.

Keywords

Anorectal malformation Incontinence Soiling Hydrocolonic sonography Bowel management 

Notes

Acknowledgments

The authors are members of the “Network for Systematic Investigation of the Molecular Causes, Clinical Implications and Psychosocial Outcome of Congenital Uro-Rectal Malformations (CURE-Net)” supported by a research grant (01GM08107) from the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF).

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Pena A (1995) Anorectal malformations. Semin Pediatr Surg 4(1):35–47PubMedGoogle Scholar
  2. 2.
    Holschneider A, Hutson J, Pena A, Bekhit E, Georgeson K, Iwai N et al (2005) Preliminary report on the international conference for the development of standards for the treatment of anorectal malformations. J Pediatr Surg 40:1521–1526CrossRefPubMedGoogle Scholar
  3. 3.
    Pena A, Guardino K, Tovilla JM et al (1998) Bowel management for fecal incontinence in patients with anorectal malformations. J Pediatr Surg 33:133–137CrossRefPubMedGoogle Scholar
  4. 4.
    Koltai JL, Pistor G (1985) Anorektale Inkontinenz. Urban and Schwarzenberg, MunichGoogle Scholar
  5. 5.
    Rubin C, Kurtz AB, Goldberg BB (1978) Water enema: a new ultrasound technique in defining pelvic anatomy. J Clin Ultrasound 6:28–33CrossRefPubMedGoogle Scholar
  6. 6.
    Limberg B (2005) Diagnosis of inflammatory and neoplastic colonic disease by sonography. J Clin Gastroenterol 1987(9):607–611Google Scholar
  7. 7.
    Levitt M, Pena A (2005) Outcomes from the correction of anorectal malformations. Curr Opin Pediatr 17(3):394–401CrossRefPubMedGoogle Scholar
  8. 8.
    Rintala R, Mildh L, Lindahl H (1992) Fecal continence and quality of life in adult patients with an operated low anorectal malformation. J Pediatr Surg 27(7):902–905CrossRefPubMedGoogle Scholar
  9. 9.
    Rintala R, Mildh L, Lindahl H (1994) Fecal continence and quality of life in adult patients with an operated high or intermediate anorectal malformation. J Pediatr Surg 29(6):770–780Google Scholar
  10. 10.
    Holschneider A (1983) Treatment and functional results of anorectal continence in children with imperforate anus. Acta Chir Belg 82(3):191–204PubMedGoogle Scholar
  11. 11.
    Holschneider A (1990) Diagnosis and primary surgical therapy of anorectal abnormalities with regard to postoperative incontinence. Zentralbl Chir 115(22):1409–1422PubMedGoogle Scholar
  12. 12.
    Holschneider A, Koebke J, Meier-Ruge W, Land N, Jesch NK (2001) Pathophysiology of chronic constipation in anorectal malformations. Eur J Pediatr Surg 11:305–310CrossRefPubMedGoogle Scholar
  13. 13.
    Pena A, Levitt MA (2002) Colonic inertia disorders. Curr Probl Surg 39:666–730PubMedGoogle Scholar
  14. 14.
    van Kuyk EM, Wissink-Essink M, Brugman-Boezeman AT, Oerlemans HM, Nijhuis-van der Sanden MW, Severijnen RS et al (2001) Multidisciplinary behavioral treatment of defecation problems: a controlled study in children with anorectal malformations. J Pediatr Surg 36:1350–1356CrossRefPubMedGoogle Scholar
  15. 15.
    Schmiedecke E, Busch M, Stamatopoulos E, Lorenz C (2008) Multidisciplinary behavioural treatment of fecal incontinence and constipation after correction of anorectal malformation. World J Pediatr 4(3):206–210CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • S. Märzheuser
    • 1
  • D. Schmidt
    • 2
  • S. David
    • 1
  • K. Rothe
    • 1
  1. 1.Department of Pediatric SurgeryCharité University Hospital BerlinBerlinGermany
  2. 2.Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and PsychotherapyCharité University Hospital BerlinBerlinGermany

Personalised recommendations