Cecal volvulus: A report of two cases occurring after the antegrade colonic enema procedure

E. R. Kokoska, C. D. Herndon, D. E. Carney, M. Lerner, J. L. Grosfeld, R. C. Rink, K. W. West

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background Many children with chronic constipation and fecal incontinence have benefited from the antegrade colonic enema (ACE) procedure. Routine antegrade colonic lavage often allows such children to avoid daytime soiling. This report describes 2 children in whom the ACE procedure was complicated by a cecal volvulus. Methods A retrospective review of 164 children with an ACE procedure was conducted. Two instances of cecal volvulus were identified. Results The first child presented with abdominal pain and difficulty intubating the ACE site. Over the subsequent day, his pain worsened, and radiographs depicted a colonic obstruction. At laparotomy, a cecal volvulus resulting in bowel necrosis was observed, and resection of the affected bowel and appendix (in the right lower quadrant) and end ileostomy was required. He subsequently had the stoma closed and a new ACE constructed with a colon flap. The second child presented with shock and evidence of an acute abdomen. At laparotomy, a cecal volvulus was noted, and ileocolic resection including the ACE stoma (located at the umbilicus) and an ileostomy and Hartmann pouch was performed. He had a protracted hospital course requiring ventilator and inotropic support. He currently is well and still has an ileostomy stoma. Conclusions A high index of suspicion for a potentially life-threatening cecal volvulus should be maintained in children undergoing an ACE procedure who present with abdominal pain, evidence of bowel obstruction, or difficulty in advancing the ACE irrigation catheter.

Original languageEnglish
Pages (from-to)916-919
Number of pages4
JournalJournal of Pediatric Surgery
Volume39
Issue number6
DOIs
StatePublished - Jun 2004

Fingerprint

Intestinal Volvulus
Enema
Ileostomy
Laparotomy
Abdominal Pain
Umbilicus
Fecal Incontinence
Acute Abdomen
Therapeutic Irrigation
Appendix
Mechanical Ventilators
Constipation
Shock
Colon
Necrosis
Catheters
Pain

Keywords

  • antegrade colonic enema
  • Cecal volvulus
  • constipation

ASJC Scopus subject areas

  • Surgery

Cite this

Kokoska, E. R., Herndon, C. D., Carney, D. E., Lerner, M., Grosfeld, J. L., Rink, R. C., & West, K. W. (2004). Cecal volvulus: A report of two cases occurring after the antegrade colonic enema procedure. Journal of Pediatric Surgery, 39(6), 916-919. https://doi.org/10.1016/j.jpedsurg.2004.02.038

Cecal volvulus : A report of two cases occurring after the antegrade colonic enema procedure. / Kokoska, E. R.; Herndon, C. D.; Carney, D. E.; Lerner, M.; Grosfeld, J. L.; Rink, R. C.; West, K. W.

In: Journal of Pediatric Surgery, Vol. 39, No. 6, 06.2004, p. 916-919.

Research output: Contribution to journalArticle

Kokoska, ER, Herndon, CD, Carney, DE, Lerner, M, Grosfeld, JL, Rink, RC & West, KW 2004, 'Cecal volvulus: A report of two cases occurring after the antegrade colonic enema procedure', Journal of Pediatric Surgery, vol. 39, no. 6, pp. 916-919. https://doi.org/10.1016/j.jpedsurg.2004.02.038
Kokoska, E. R. ; Herndon, C. D. ; Carney, D. E. ; Lerner, M. ; Grosfeld, J. L. ; Rink, R. C. ; West, K. W. / Cecal volvulus : A report of two cases occurring after the antegrade colonic enema procedure. In: Journal of Pediatric Surgery. 2004 ; Vol. 39, No. 6. pp. 916-919.
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AB - Background Many children with chronic constipation and fecal incontinence have benefited from the antegrade colonic enema (ACE) procedure. Routine antegrade colonic lavage often allows such children to avoid daytime soiling. This report describes 2 children in whom the ACE procedure was complicated by a cecal volvulus. Methods A retrospective review of 164 children with an ACE procedure was conducted. Two instances of cecal volvulus were identified. Results The first child presented with abdominal pain and difficulty intubating the ACE site. Over the subsequent day, his pain worsened, and radiographs depicted a colonic obstruction. At laparotomy, a cecal volvulus resulting in bowel necrosis was observed, and resection of the affected bowel and appendix (in the right lower quadrant) and end ileostomy was required. He subsequently had the stoma closed and a new ACE constructed with a colon flap. The second child presented with shock and evidence of an acute abdomen. At laparotomy, a cecal volvulus was noted, and ileocolic resection including the ACE stoma (located at the umbilicus) and an ileostomy and Hartmann pouch was performed. He had a protracted hospital course requiring ventilator and inotropic support. He currently is well and still has an ileostomy stoma. Conclusions A high index of suspicion for a potentially life-threatening cecal volvulus should be maintained in children undergoing an ACE procedure who present with abdominal pain, evidence of bowel obstruction, or difficulty in advancing the ACE irrigation catheter.

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