International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, United States.
International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, United States.
J Pediatr Surg. 2021 Feb;56(2):424-428. doi: 10.1016/j.jpedsurg.2020.10.027. Epub 2020 Oct 31.
BACKGROUND/PURPOSE: Enemas have become a common practice for treating fecal incontinence and severe constipation. Several patients receiving enemas complained of severe, colicky, abdominal pain during enema administration and complained that the duration for fluid to pass was progressively increasing. Contrast studies showed a startling picture of severe right colon dilatation and a spastic, narrow, left colon. An investigation was started to seek the origin and possible management of this condition.
Medical and radiologic records were reviewed retrospectively, with emphasis on the type and ingredients of enemas used, the duration the patients had been receiving enemas, and their original diagnosis. A literature review was done on previous reports of this condition and publications related to long-term use of enemas.
This series included 22 patients (average age, 19.6 years; range, 8-54) with fecal incontinence due to anorectal malformations (10 cases), myelomeningocele (5), cloaca (2), severe colonic dysmotility (2), Hirschsprung's disease (2), and sacrococcygeal teratoma (1). The average duration of enema use was 13.7 years (range, 4-45). The composition of the enemas included saline/glycerin (six cases), only saline solution (five), saline/glycerin/soap (four), plain water (three), and one case each of molasses/milk, saline/glycerin/soap/phosphate, saline/phosphate, and only phosphate. The enemas were performed in an antegrade fashion in 21 cases and rectally in 1. All patients had a dilated right colon and a narrow, spastic, left, transverse, and descending colon. Four patients underwent colonoscopy, colonic manometry, and mucosal biopsies, which did not help in explaining the etiology of the problem. In the literature, 43 reports mentioned a "long-term follow-up" for the administration of enemas, but we could not find a description of symptoms, such as in our cases.
An intriguing and, to our knowledge, previously unreported complication of chronic enema use is presented. We call attention to an overly concerning complication and report our findings in the hope that they will aid and stimulate more investigations into this condition. Several hypotheses to explain the cause are presented, as well as potential treatment options.
背景/目的：灌肠已成为治疗粪便失禁和严重便秘的常见方法。一些接受灌肠的患者抱怨在灌肠过程中出现严重的绞痛性腹痛，并抱怨液体通过的时间逐渐延长。对比研究显示出严重的右结肠扩张和痉挛性、狭窄的左结肠的惊人图像。因此，开始调查这种情况的根源和可能的治疗方法。
回顾性审查医疗和放射学记录，重点关注使用的灌肠类型和成分、患者接受灌肠的时间以及他们的原始诊断。对该病症的以往报告和与长期使用灌肠相关的出版物进行了文献回顾。
该系列包括 22 例因肛门直肠畸形（10 例）、脊髓脊膜膨出（5 例）、泄殖腔（2 例）、严重结肠动力障碍（2 例）、巨结肠病（2 例）和骶尾部畸胎瘤（1 例）导致粪便失禁的患者（平均年龄 19.6 岁；范围 8-54 岁）。灌肠的平均使用时间为 13.7 年（范围 4-45 年）。灌肠液的成分包括盐水/甘油（6 例）、仅生理盐水（5 例）、盐水/甘油/肥皂（4 例）、清水（3 例）以及 1 例分别为糖蜜/牛奶、盐水/甘油/肥皂/磷酸盐、盐水/磷酸盐和仅磷酸盐。21 例采用顺行灌肠，1 例采用直肠灌肠。所有患者均有扩张的右结肠和狭窄、痉挛性的左、横、降结肠。4 例患者接受了结肠镜检查、结肠测压和黏膜活检，但均未能帮助解释该问题的病因。在文献中，有 43 篇报道提到了灌肠的“长期随访”，但我们无法找到与我们的病例相似的症状描述。
提出了慢性灌肠使用的一个有趣的、据我们所知以前未报道过的并发症。我们提请注意这种令人担忧的并发症，并报告我们的发现，希望能有助于并激发对这种情况的更多研究。提出了几种解释病因的假设以及潜在的治疗选择。
