Abstract
PURPOSE: This study aimed to evaluate the colorectal luminal transport obtained by retrograde colonic washout with a new scintigraphic technique. METHODS: Nineteen patients (5 with spinal cord lesion, 6 with idiopathic fecal incontinence, and 8 with idiopathic constipation) treated with retrograde colonic washout took indium-111–labeled polystyrene pellets to label the bowel contents. Technetium-99m-diethylene-triamine-pentaacetic acid was mixed with the irrigation fluid to assess its extent within the colorectum. Scintigraphy was performed before and after a standardized washout procedure. The colorectum was divided into four segments: the cecum and ascending colon, the transverse colon, the descending colon, and the rectosigmoid. Assuming ordered evacuation of the colorectum, the contribution of each colonic segment to the total evacuation was expressed in percent of the original segmental counts. The contributions of each segment were summed to reach a total defecation score (range, 0–400), and directional segmental transports were estimated. RESULTS: The defecation score in patients with idiopathic constipation (median, 59; range, 21–130) differed significantly (P < 0.05) from the scores in those with spinal cord lesions (median, 204; range, 108–323) and idiopathic fecal incontinence (median, 188; range, 155–234). Thus, patients with spinal cord lesion or idiopathic fecal incontinence were able to empty most of the rectosigmoid and most of the descending colon, but those with idiopathic constipation could only empty 59 percent of the rectosigmoid. The irrigation fluid on average reached a point just beyond the right colic flexure that correlated with the defecation score (r2 = 0.58, P < 0.001). CONCLUSION: The effect of retrograde colonic washout was significantly better in spinal cord lesion and idiopathic fecal incontinence than in idiopathic constipation, and its effect correlated with the extent to which the irrigation fluid had entered the colorectum.
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References
B Shandling RF Gilmour (1987) ArticleTitleThe enema continence catheter in spina bifida J Pediatr Surg 22 271–273
GK Blair K Djonlic GC Fraser WD Arnold JJ Murphy B Irwin (1992) ArticleTitleThe bowel management tube J Pediatr Surg 27 1269–1272
PF Eire RV Cives MC Gago (1998) ArticleTitleFaecal incontinence in children with spina bifida Spinal Cord 36 774–776
J Walker P Webster (1989) ArticleTitleSuccessful management of faecal incontinence using the enema continence catheter Z Kinderchir 44 44–45
GS Liptak GM Revell (1992) ArticleTitleManagement of bowel dysfunction in children with spinal cord disease or injury by means of the enema continence catheter J Pediatr 12021 190–194
M Scholler-Gyure C Nesselaar H van Wieringen JD van Gool (1996) ArticleTitleTreatment of defecation disorders by colonic enemas in children with spina bifida Eur J Pediatr Surg 6 32–34
P Christensen B Kvitzau K Krogh S Buntzen S Laurberg (2000) ArticleTitleNeurogenic colorectal dysfunction—use of new antegrade and retrograde colonic wash-out methods Spinal Cord 38 255–251
K Krogh B Kvitzau T Jørgensen S Laurberg (1999) ArticleTitleBehandling af anal inkontinens og obstipation ved hjælp af transanal irrigation Ugeskr Laeger 161 253–256
JW Briel WR Schouten EA Vlot S Smits I van Kessel (1997) ArticleTitleClinical value of colonic irrigation in patients with continence disturbances Dis Colon Rectum 40 802–805
JR Malagelada JS Robertson ML Brown et al. (1984) ArticleTitleIntestinal transit of solid and liquid components of a meal in health Gastroenterology 87 1255–1263
JL Madsen NE Larsen J Hilsted H Worning (1991) ArticleTitleScintigraphic determination of gastrointestinal transit times Scand J Gastroenterol 26 1263–1271
B Krevsky LS Malmud F D’Ercole AH Maurer RS Fisher (1986) ArticleTitleColonic transit scintigraphy Gastroenterology 91 1102–1112
A Notghi R Hutchinson D Kumar NB Smith LK Harding (1994) ArticleTitleSimplified method for the measurement of segmental colonic transit time Gut 35 976–971
JL Madsen M Jensen (1989) ArticleTitleGastrointestinal transit of technetium-99m-labeled cellulose fiber and indium-111-labeled plastic particles J Nucl Med 30 402–406
HH Meyhoff B Andersen SL Nielsen (1990) ArticleTitleColostomy irrigation Br J Surg 77 1185–1186
F Herbst MA Kamm GP Morris K Britton J Woloszko RJ Nicholls (1997) ArticleTitleGastrointestinal transit and prolonged ambulatory colonic motility in health and faecal incontinence Gut 41 381–389
DZ Lubowski AP Meagher RC Smart SP Butler (1995) ArticleTitleScintigraphic assessment of colonic function during defaecation Int J Colorectal Dis 10 91–93
H Abrahamsson S Antov I Bosaeus (1988) ArticleTitleGastrointestinal and colonic segmental transit time evaluated by a single abdominal x-ray in healthy subjects and constipated patients Scand J Gastroenterol Suppl 152 72–80
JM Hinton JE Lennard-Jones AC Young (1969) ArticleTitleA new method for studying gut transit times using radioopaque markers Gut 10 842–847
WG Thompson GF Longstreth DA Drossman KW Heaton EJ Irvine SA Muller-Lissner (1999) ArticleTitleFunctional bowel disorders and functional abdominal pain Gut 45 43–47
M Proano M Camilleri SF Phillips ML Brown GM Thomforde (1990) ArticleTitleTransit of solids through the human colon Am J Physiol 25861 856–862
F Charles M Camilleri SF Phillips GM Thomforde LA Forstrom (1995) ArticleTitleScintigraphy of the whole gut Mayo Clin Proc 70 113–118
JG Hardy AC Perkins (1985) ArticleTitleValidity of the geometric mean correction in the quantification of whole bowel transit Nucl Med Commun 6 217–224
N Olsen K Krogh P Christensen JL Madsen S Laurberg (2001) ArticleTitleColorectal scintigraphy during defecation—a method study [abstract] Eur J Nucl Med 28 1031–224
JC Debongnie SF Phillips (1978) ArticleTitleCapacity of the human colon to absorb fluid Gastroenterology 74 698–703
JM Gattuso MA Kamm C Myers B Saunders A Roy (1996) ArticleTitleEffect of different infusion regimens on colonic motility and efficacy of colostomy irrigation Br J Surg 83 1459–1462
JD Hardcastle CV Mann (1970) ArticleTitlePhysical factors in the stimulation of colonic peristalsis Gut 11 41–46
F Narducci G Bassotti M Gaburri CT Speakman A Morelli (1985) ArticleTitleDistension stimulated motor activity of the human transverse, descending and sigmoid colon Gastroenterology 88 1515–46
G Bassotti M Gaburri BP Imbimbo et al. (1988) ArticleTitleColonic mass movements in idiopathic chronic constipation Gut 29 1173–1179
DJ Waldron D Kumar RI Hallan DL Wingate NS Williams (1990) ArticleTitleEvidence for motor neuropathy and reduced filling of the rectum in chronic intractable constipation Gut 31 1284–1288
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Christensen, P., Olsen, N., Krogh, K. et al. Scintigraphic Assessment of Retrograde Colonic Washout in Fecal Incontinence and Constipation. Dis Colon Rectum 46, 68–76 (2003). https://doi.org/10.1007/s10350-004-6498-0
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DOI: https://doi.org/10.1007/s10350-004-6498-0