Grasshoff-Derr Sabine, Backhaus Kathrin, Hubert Désirée, Meyer Thomas
Pediatric Surgery Unit, Department of Surgery, University of Wuerzburg, Oberdürrbacher Strasse 6, 97080, Wuerzburg, Germany.
Pediatr Surg Int. 2011 Oct;27(10):1099-103. doi: 10.1007/s00383-011-2950-0.
Patients with anorectal malformation (ARM) frequently suffer postoperatively from fecal incontinence (25%) and constipation (75%). Depending on the type of malformation, some cases will not have a chance to control bowel movements. For these patients with fecal incontinence, we started to combine bowel management with hydrocolonic ultrasound to keep them clean.
From January 2003 until December 2010, overall 63 patients (aged 4-22 years) with ARM and fecal incontinence were treated by specific bowel management. Hydrocolonic ultrasound was used as a diagnostic parameter to determine stool texture and activity of the colon as well as to determine the appropriate volume which is needed to clean the colon. Each patient received an individually adjusted enema. Patients were classified into two groups: Group I: patients with incontinence and tendency to constipation and Group II: patients with incontinence and tendency to diarrhea. Subsequent controls were focused on problems such as bowel dilatation, bowel motility, constipation or too little enema due to the patient's growing.
Up to now, 63 patients were investigated in our study (Group I n = 37 patients and Group II n = 26 patients). In addition, the patients were classified according to the type of malformation. With specific bowel management combined with hydrocolonic ultrasound, 97% of patients in Group I (36/37) stayed clean (demonstration of complete bowel control). All 57.7% of patients in Group II (15/26) stayed clean after daily bowel management, and 34.6% with smearing less than three times per week (n = 9/26). In addition, a specific diet and constipating medication were often necessary to get patients in Group II clean.
Treating young patients with fecal incontinence is always a challenge. Hydrocolonic ultrasound diagnostically conclusive and less invasive. The combination with bowel management results in better bowel control and serves as a valuable tool in affected infants and adolescents. Thus, hydrocolonic ultrasound may be an essential instrument in postoperative diagnostic procedure and therapy of patients with fecal incontinence.
肛门直肠畸形（ARM）患者术后常出现大便失禁（25%）和便秘（75%）。根据畸形类型，部分病例将没有机会控制排便。对于这些大便失禁的患者，我们开始将肠道管理与结肠水疗超声相结合，以保持他们的清洁。
从2003年1月至2010年12月，共有63例年龄在4至22岁的ARM和大便失禁患者接受了特定的肠道管理。结肠水疗超声被用作诊断参数，以确定粪便质地、结肠活动情况以及确定清洁结肠所需的合适容量。每位患者接受个体化调整的灌肠。患者被分为两组：第一组：有失禁和便秘倾向的患者；第二组：有失禁和腹泻倾向的患者。后续的对照关注诸如肠扩张、肠道蠕动、便秘或因患者生长导致灌肠量过少等问题。
到目前为止，我们的研究中调查了63例患者（第一组37例，第二组26例）。此外，患者还根据畸形类型进行了分类。通过特定的肠道管理结合结肠水疗超声，第一组97%的患者（36/37）保持清洁（显示完全排便控制）。第二组所有患者中，57.7%（15/26）在每日肠道管理后保持清洁，34.6%的患者每周涂抹少于三次（n = 9/26）。此外，对于第二组患者，通常需要特定的饮食和致便秘药物才能使其保持清洁。
治疗大便失禁的年轻患者始终是一项挑战。结肠水疗超声诊断结论明确且侵入性较小。与肠道管理相结合可实现更好的排便控制，是受影响婴幼儿和青少年的一项有价值工具。因此，结肠水疗超声可能是大便失禁患者术后诊断程序和治疗中的一项重要手段。
