ABSTRACT
BACKGROUND: Treatment of functional constipation (FC) in children with autism spectrum disorder (ASD) is challenging due to sensory and behavioral issues. We aimed to understand whether antegrade continence enemas (ACEs) are successful in the treatment of FC in children with ASD. METHODS: A single-institution retrospective review was performed in children diagnosed with ASD and FC who underwent appendicostomy or cecostomy placement from 2007 to 2019. Descriptive statistics regarding soiling and complications were calculated. RESULTS: There were 33 patients included, with a median age of 9.7 years at the time of ACE initiation. The average intelligence quotient was 63.6 (SD = 18.0, n = 12), the average behavioral adaptive score was 59.9 (SD = 11.1, n = 13), and the average total Child Behavioral Checklist score was 72.5 (SD = 7.1, n = 10). Soiling rates were significantly lower following ACE initiation (42.3% vs. 14.8%, p = 0.04). Behavioral issues only prevented 1 patient (3.0%) from proper ACE use. Eleven patients (36.6%) were able to transition to laxatives. There were significant improvements in patient-reported outcomes measures and quality of life. CONCLUSION: Placement of an appendicostomy or cecostomy for management of FC in children with severe ASD was successful in treating constipation and improving quality of life.
Subject(s)
Autism Spectrum Disorder , Fecal Incontinence , Child , Humans , Quality of Life , Autism Spectrum Disorder/complications , Autism Spectrum Disorder/therapy , Constipation/therapy , Constipation/complications , Cecostomy/adverse effects , Enema/adverse effects , Retrospective Studies , Fecal Incontinence/etiology , Fecal Incontinence/therapy , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Child , Young Adult , Anaphylaxis/chemically induced , Honey/adverse effects , Enema/adverse effects , Administration, RectalABSTRACT
Los enemas fosfatados son utilizados frecuentemente en el tratamiento de la constipación. Errores en la posología pueden producir complicaciones graves. Objetivo: Reportar un caso de toxicidad grave por enema fosfatado en un pre escolar sin factores de riesgo. Caso clínico: Paciente de 2 años con constipación funcional, evaluada en servicio de urgencia por dolor abdominal a quién se le diagnosticó un fecaloma impactado. Recibió 2 dosis de enema de fosfato, medio frasco de Fleet® adulto (Synthon, Chile) por vez, sin resolución de su fecaloma, decidiéndose hospitalización para proctoclisis. Posterior al ingreso presentó un cuadro clínico de tetania. Ingresó a la Unidad de Paciente Crítico donde se confirmó una hiperfosfemia e hipocalcemia secundaria. Se realizó corrección electrolítica progresiva, retiro de enema fosfatado residual del recto e hiperhidratación forzando diuresis. La tetania cedió 2 horas después del ingreso sin otras complicaciones. Se realizó proctoclisis y fue dada de alta a los 3 días. Conclusión: Los enemas fosfatados pueden presentar complicaciones graves en niños sin factores de riesgo. Errores en la posología son la causa más frecuente de toxicidad en este grupo, pero esta puede estar favorecida también por una administración y eliminación inadecuadas. Pediatras y personal de salud que atiende a niños deben conocer factores de riesgo, signos y síntomas de intoxicación por enemas fosfatados.
Phosphate enemas are frequently used in the treatment of constipation. Errors in dosage and administration can lead to severe complications. Objective: To report a case of severe toxicity of phosphate enemas in a child with no risk factors. Case: 2 years old female, with functional constipation, was brought to emergency department because abdominal pain. She was diagnosed with fecal impaction and received half a bottle of Fleet Adult® (Laboratorio Synthon, Chile) two times, with no clinical resolution, deciding to start proctoclisis in pediatric ward. Soon after admission, she presented painful tetany, but alert and oriented. Patient was transferred to PICU where severe hyperphosphatemia and secondary hypocalcemia were confirmed. Her treatment included electrolyte correction; removal of residual phosphate enema and hyperhydration. Tetany resolved over 2 hours after admission and no other complications. Proctoclisis was performed and patient was discharged three days after admission with pharmacological management of constipation. Conclusion: Phosphate enemas may cause serious complications in children with no risk factors. Errors in dosage, administration and removal of the enema are causes of toxicity in this group. Pediatricians and health personnel must be aware of risks and signs of toxicity of phosphate enema.
Subject(s)
Humans , Female , Child, Preschool , Phosphates/adverse effects , Tetany/chemically induced , Constipation/therapy , Enema/adverse effects , Hyperphosphatemia/chemically induced , Phosphates/therapeutic use , Tetany/diagnosis , Hyperphosphatemia/diagnosisABSTRACT
Antecedentes y objetivos: La colonoscopia con polipectomía con fines de cribado reduce la incidencia del cáncer colorrectal y la mortalidad por esta enfermedad. Una preparación colónica aceptable es una de las claves para conseguir mejores resultados con esta técnica. Las soluciones de fosfato de sodio oral (OSP) fueron muy utilizadas en la década de los noventa del siglo pasado. Su eficacia era similar a la de las soluciones de polietilenglicol (PEG), pero más baratas y con una administración sencilla. Se han descrito series de casos de pacientes con insuficiencia renal aguda provocada por OSP. Sin embargo, en cohortes amplias de pacientes no se observó ninguna diferencia en la incidencia de daño renal entre estas dos soluciones. Métodos: Entre 2006 y 2009 identificamos 12 casos de nefropatía por fosfato tras preparación con OSP para colonoscopia. Se realizó el seguimiento de todos los pacientes durante 6 meses. Todos los pacientes habían recibido una única dosis. Resultados: Analizamos 12 casos de nefropatía por fosfato; 3 se manifestaron con IRA y 9 presentaron daño renal crónico. Cuatro de los casos se confirmaron mediante biopsia renal. Un paciente con IRA precisó hemodiálisis en el momento del diagnóstico, sin que experimentara recuperación posterior. Dos pacientes (ambos con daño crónico) recuperaron totalmente su función renal anterior. Los demás pacientes (9) presentaron una pérdida media en la filtración glomerular estimada de 24ml/min/1,73m2. Conclusiones: El uso de OSP puede ocasionar daño renal tanto agudo como crónico. Sin embargo, el daño crónico fue el más frecuente. Ambas formas de presentación suponen una pérdida considerable e irreversible de función renal. Nuevos estudios que analicen el daño renal secundario a preparación colónica deben considerar estos dos patrones distintos de daño (AU)
Background and objectives: Screening colonoscopy with polipectomy reduces colonorectal cancer incidence and mortality. An adequate bowel cleansing is one of the keys to achieving best results with this technique. Oral sodium phosphate solution (OSP) had a widespread use in the 90s decade. Its efficacy was similar to polyethylene glycol (PEG) solution, but with less cost and convenient administration. Series of patients with acute renal failure due to OSP use have been reported. However, large cohorts of patients found no difference in the incidence of renal damage between these two solutions. Methods: From 2006 to 2009 we identified twelve cases of phosphate nephropathy after colonoscopy prepared with OSP. All patients were followed up to six months. All patients had received just a single dose. Results: We analyzed 12 cases with phosphate nephropathy; three patients debuted with AKI and nine patients had chronic renal injury. Four cases were confirmed with renal biopsy. One patient with AKI needed hemodialysis at diagnosis without subsequent recovery. Two patients (both with chronic damage) fully recovered their previous renal function. The remaining patients (nine) had an average loss of estimated glomerular filtration rate of 24ml/min/1.73m2. Conclusions: The use of OSP can lead to both acute and chronic renal damage. However, chronic injury was the most common pattern. Both forms of presentation imply a significant and irreversible loss of renal function. Further studies analyzing renal damage secondary to bowel cleaning should consider these two different patterns of injury (AU)
Subject(s)
Humans , Colonoscopy/methods , Laxatives/adverse effects , Acute Kidney Injury/chemically induced , Risk Factors , Enema/adverse effects , BiopsyABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Child , Constipation/complications , Enema/adverse effects , Phosphates/adverse effects , Risk FactorsABSTRACT
No disponible
Subject(s)
Humans , Male , Aged, 80 and over , Enema/adverse effects , Phosphates/adverse effects , Hyperphosphatemia/chemically induced , Intestinal Perforation/etiology , Rectum/injuries , Risk FactorsABSTRACT
No disponible
Subject(s)
Humans , Male , Child, Preschool , Phosphorus/blood , Hypocalcemia/etiology , Saline Solution, Hypertonic/adverse effects , Enema/adverse effects , Constipation/complications , Water-Electrolyte Imbalance/etiologyABSTRACT
Se ha descrito que la tolerancia alimentaria en el extremo prematuro se asocia a una precoz eliminación de meconio. Estudios prospectivos, randomizados o con controles históricos de estimulación de evacuación de meconio reportan diferentes resultados. El objetivo de este estudio fue evaluar el uso sistemático de enemas que aceleren la evacuación de meconio, y por ende la tolerancia alimentaria. Pacientes y Método: Estudio controlado, aleatorizado y multicéntrico que evaluó el uso de enemas de solución fisiológica con glicerina (0,8 ml de glicerina + 3 ml de solución fisiológica o 1 ml de glicerina + 5 ml de solución fisiológica según peso al nacer menor o mayor de 800 g, respectivamente) versus simulación, iniciado en los primeras 96 h de vida, en prematuros con peso al nacimiento entre 500 y 1.250 g. Se registraron antecedentes maternos (parto prematuro, infección ovular, síndrome hipertensivo del embarazo, administración de sulfato de magnesio, y corticoides prenatales, doppler fetal alterado, tipo de parto, sexo, peso y edad gestacional, evaluación de apgar y necesidad de ventilación asistida y oxígenoterapia) y nutricionales (edad al alcanzar volúmenes de alimentación de 100 ml//kg/día y alimentación enteral completa, edad para eliminar meconio, número de días en nutrición parenteral, peso a los 28 días, volúmenes semanales de leche materna y fórmula de prematuros). Resultados: En 101 sujetos incluidos en el estudio, no se obtienen diferencias significativas en la variable principal de edad para alcanzar el aporte enteral total o los 100 ml por kg por día. Tampoco se observan diferencias en las variables secundarias: número de episodios de sepsis tardías con o sin hemocultivo positivo, hiperbilirrubinemia, enterocolitis necrotizante o hemorragia intracraneana...
Introduction: It has been reported that feeding tolerance in preterm infants is associated with an early passage of meconium. Prospective, randomized or historical control studies that stimulate meconium evacuation have reported varied results. This study was intented to evaluate the use of enemas to speed up meconium evacuation, facilitating feeding tolerance. Patients and Method: A controlled multicenter randomized trial that evaluated the use of physiological saline enemas with glycerol (0.8 ml glycerol + 3 ml saline or 1 ml glycerol + 5 ml saline depending on babies weighing less or more than 800 g at birth, respectively) versus simulation. This procedure was performed in the first 96 hours of life in infants with birth weight between 500 and 1,250 g. Maternal (preterm delivery, clinical chorioamnionitis, gestational hypertension, administration of magnesium sulfate and prenatal corticosteroids, fetal Doppler altered, type of delivery, gender, weight and gestational age, assessment of Apgar and need for assisted ventilation and oxygenotherapy) and nutritional history (age when feeding volumes of 100 ml/kg/day and full enteral feeding were reached, age to remove meconium, number of days on parenteral nutrition, weight at 28 days, weekly volumes of breast milk and preterm formula) were described. Results: No significant differences were obtained regarding the age to reach full enteral intake or 100 ml/kg/day were found among the 101 patients in the study. Also, no differences in the following secondary variables are observed: number of episodes of late sepsis with or without positive blood culture, hyperbilirubinemia, necrotizing enterocolitis and intraventricular hemorrhage...
Subject(s)
Humans , Infant, Newborn , Enema/methods , Infant, Premature, Diseases/therapy , Meconium , Intestinal Obstruction/therapy , Clinical Protocols , Enteral Nutrition , Enema/adverse effects , Gastrointestinal Motility , Infant, Very Low Birth Weight , Logistic Models , Multicenter Studies as TopicABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Colitis/complications , Colitis/diagnosis , Enema/adverse effects , Enema/methods , Abdominal Pain/complications , Abdominal Pain/etiology , Colonoscopy/methods , Colonoscopy , Constriction, Pathologic/complications , Leukocytosis/complications , Leukocytosis/diagnosis , Peritoneum/pathology , Peritoneum , Tomography, Emission-Computed , SigmoidoscopyABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Enema/adverse effects , Hypernatremia/etiology , Ketosis/etiology , Renal Insufficiency/etiology , ColonoscopyABSTRACT
No disponible
No disponible
Subject(s)
Humans , Male , Aged, 80 and over , Hyperphosphatemia/complications , Enema/adverse effects , Acute Kidney Injury/chemically induced , Phosphates/adverse effects , Colonoscopy/methodsABSTRACT
OBJECTIVE: The aim of the study was to determine which was the optimal side for the conduit to be placed (right or left colon) for antegrade continence enema implantation. MATERIALS AND METHODS: Between July 1999 and March 2006, 31 patients underwent the construction of a catheterizable conduit using the Malone principle (MACE) In 22 cases the conduit was re-implanted in the right colon and in 9 cases in the left colon. There were 20 male patients and 11 female patients, with a mean age of 10.23 years. The follow-up period varied from 3 from 83 months (average 25 months). Right and left implantation of the conduit in the colon were compared with regards to the presence of complications, volume of the solution utilized, frequency of colonic lavage, time needed for performing the enema, and degree of satisfaction. RESULTS: One patient with the conduit in the right colon, using the appendix, lost the mechanism after two month follow-up. Thirty patients remain clean and are all capable of performing self-catheterization. No statistically significant differences were found between the groups regarding the variables studied: complications (p = 1.000), solution volume (p = 0.996), time required (p = 0.790) and patient's rating (p = 0.670). The lavage frequency required for patients with the conduit in the right colon may be lower. CONCLUSION: The MACE principle was considered effective for treating fecal retention and leaks, independent of the implantation site. The success of this surgery appears to be directly related to the patient's motivation and not to the technique utilized.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Colon/surgery , Enema/methods , Fecal Incontinence/surgery , Constipation/surgery , Enema/adverse effects , Follow-Up Studies , Treatment OutcomeABSTRACT
Avaliou-se o efeito de diferentes soluções de enema sobre os parâmetros clínicos de eqüinos hígidos. Foram utilizados 15 eqüinos adultos, distribuídos em três grupos de cinco animais cada: grupo 1 - tratados com água de torneira mais sabão neutro; grupo 2 - tratados com solução isotônica e grupo 3 - tratados com água de torneira mais vaselina. O efeito das soluções de enema sobre os parâmetros clínicos variou em função do tipo de solução infundida. A solução com menor efeito sobre os parâmetros clínicos foi a isotônica. A solução de água de torneira e sabão neutro desencadeou um aumento da temperatura retal e edema da mucosa retal. Embora as três soluções tenham se mostrado efetivas em hidratar e amolecer as fezes, a solução de água com sabão foi a que apresentou o melhor efeito.
The effect of three different enema solutions on clinical parameters of equines was studied using 15 healthy adult animals. They were alloted into three groups of five animals each: group 1 - treated with tap water associated with neuter soap; group 2 -treated with isotonic solution; and group 3 - treated with tap water associated with vaseline. Effects of enema solutions on clinical parameters were observed. Isotonic solution caused less alteration on clinical parameters. Tap water and soap enema induced inflammatory reaction on colon mucosa. Even though all three solutions showed effectiveness in hydrating and softening the feces, the treatment with water plus soap showed the best results.
Subject(s)
Animals , Equidae , Enema/adverse effects , Enema/veterinaryABSTRACT
PURPOSE: To study the effects on the water, electrolyte, and acid-base balances in rabbits submitted to antegrade enema with different solutions through appendicostomy. METHODS: Forty male New Zealand rabbits were submitted to appendicostomy, and distributed in 4 groups, according to the antegrade enema solution: PEG group, polyethylene glycol electrolyte solution (n=10); ISS group, isotonic saline solution (n=10); GS group, glycerin solution (n=10); SPS group, sodium phosphate solution (n=10). After being weighed, arterial blood gas analysis, red blood count, creatinine and electrolytes were measured at 4 times: preoperatively (T1); day 6 postop, before enema (T2); 4h after enema (T3); and 24h after T3 (T4). RESULTS: In PEG group occurred Na retention after 4h, causing alkalemia, sustained for 24h with HCO3 retention. In ISS group occurred isotonic water retention and hyperchloremic acidosis after 4h, which was partially compensated in 24h. GS group showed metabolic acidosis after 4h, compensated in 24h. In SPS group occurred hypernatremic dehydration, metabolic acidosis in 4h, and hypokalemia, hypocalcemia, hypomagnesemia, and metabolic alkalosis with partially compensated dehydration in 24h. CONCLUSIONS: All solutions used in this study caused minor alterations on water, electrolyte or acid-base balances. The most intense ones were caused by hypertonic sodium phosphate solution (SPS) and isotonic saline solution (ISS) and the least by polyethyleneglycol electrolyte solution (PEG) and glycerin solution 12 percent (GS).
OBJETIVO: Estudar os efeitos no equilíbrio hídrico, eletrolítico e ácido-base, do enema anterógrado com diferentes soluções em coelhos através de apendicostomia. MÉTODOS: 40 coelhos Nova Zelândia, machos, submetidos a apendicostomia, distribuídos em quatro grupos segundo a solução de enema: grupo PEG (n = 10) solução de polietilenoglicol com eletrólitos; grupo SF (n = 10) solução fisiológica; grupo SG (n = 10) solução glicerinada; grupo FS (n = 10) solução de fosfato de sódio. Realizou-se pesagem, gasometria arterial, série vermelha, creatinina e ionograma, em quatro tempos: TI (pré-operatório); T2 (6o PO antes do enema); T3 (4h após enema); T4 (24h após T3). RESULTADOS: No PEG ocorreu retenção de Na em 4h, com alcalemia por retenção de HCO3, mantida por 24h. No SF ocorreu retenção hídrica isotônica e acidose hiperclorêmica em 4h, resolvidos parcialmente com 24h. No SG ocorreu acidose metabólica hiperclorêmica em 4h, compensada com 24h. No FS ocorreu desidratação hipenatrêmica, acidose metabólica com ânion gap elevado em 4h, hipopotassemia, hipocalcemia, hipomagnesemia e alcalose metabólica com recuperação parcial da desidratação em 24h. CONCLUSÕES: Todas as soluções empregadas neste estudo causam alterações de pouca intensidade no equilíbrio hídrico, eletrolítico ou ácido-base. As mais intensas foram causadas pela solução de fosfato de sódio e solução fisiológica, e as menos intensas pela solução de polietilenoglicol com eletrólitos e solução glicerinada.
Subject(s)
Animals , Male , Rabbits , Acid-Base Equilibrium/drug effects , Enema/methods , Glycerol/adverse effects , Phosphates/adverse effects , Polyethylene Glycols/adverse effects , Water-Electrolyte Balance/drug effects , Acid-Base Imbalance/blood , Acid-Base Imbalance/etiology , Appendix/surgery , Cathartics/administration & dosage , Cathartics/adverse effects , Enema/adverse effects , Glycerol/administration & dosage , Isotonic Solutions/administration & dosage , Isotonic Solutions/adverse effects , Models, Animal , Magnesium Deficiency/blood , Magnesium Deficiency/etiology , Phosphates/administration & dosage , Polyethylene Glycols/administration & dosage , Time Factors , Water-Electrolyte Imbalance/blood , Water-Electrolyte Imbalance/etiologyABSTRACT
Background: Colonoscopy is a well established diagnostic and therapeutic procedure in pediatrics. Aim: To evaluate colon preparation alternatives for colonoscopy or sigmoidoscopy, type of sedation, clinical indications and findings. Patients and methods: Prospective study of 123 children referred for colonoscopy. Demographic data, type of colon preparation, sedation, type of endoscope and endoscopic results were obtained. The following day, a phone interview was carried out inquiring about duration, quality and adverse effects of the sedation and procedure. Results: Seventy one boys (58%) and 52 girls (42%) with a mean age of 6.7±4.4 years, were recruited. The main indication was lower gastrointestinal bleeding (71%). The different colon preparations produced elimination of clear liquid stools in 50%, non transparent liquid in 23%, semi liquid in 22% and solid in 6% of the patients. Most common side effects were abdominal distension (20%) and nausea (16.8%). The most commonly used drugs were midazolam (76%) and demerol (43%). The average duration of the procedure was 18.3 minutes (range: 4-50). The most common findings were rectal polyps (18.7%) and hemorrhagic colitis (14.6%). In 77% of cases, the sedation was considered very good or good. Colon visualization was described as very good (51%) or good (36%). Seventy three percent of children had complete amnesia. The most common adverse effect was vomiting (7.5%). Conclusion: Lower endoscopies are feasible procedures to carry out in children, in an ambulatory basis, with intravenous sedation and minimum adverse effects.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Colonoscopy/standards , Outcome and Process Assessment, Health Care , Postoperative Care/standards , Preoperative Care/standards , Administration, Oral , Administration, Rectal , Analysis of Variance , Colonoscopy/adverse effects , Enema/adverse effects , Gastrointestinal Hemorrhage/surgery , Patient Satisfaction , Postoperative Care/adverse effects , Preoperative Care/adverse effects , Prospective Studies , Sigmoidoscopy/adverse effects , Sigmoidoscopy/standardsABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Enema/adverse effects , Phosphorus/blood , Renal Insufficiency/complications , Risk Factors , Abdominal Pain/etiologyABSTRACT
No disponible