(Percutaneous Endoscopic Cecostomy, Laparoscopic Cecostomy Tube Placement, Antegrade Enema)
Cecostomy is a fairly new surgical procedure that is used to clear the bowels of fecal matter. It continues to be researched to improve the technique. It’s typically used for children with fecal incontinence related to severe disorders. Fecal incontinence is the inability to control your bowels, which can involve symptoms ranging from severe constipation to having a bowel movement at an unexpected or embarrassing time.
Children with fecal incontinence often have severe constipation. In some cases, liquid fecal matter bypasses the solid fecal matter and leaks out, which can cause embarrassment and frustration for the child.
Cecostomy differs slightly from the traditional enema that is used to relieve constipation. An enema is given directly through the rectum to promote the release of fecal matter. But a cecostomy is known as an “antegrade enema.”
In the cecostomy, a tube (catheter) is used for the procedure. This catheter is inserted into the cecum, which is the first portion of the bowel, or large intestines. The cecum is located in the lower right abdomen. Liquid medication is injected into the cecum through this tube, which helps coax the fecal matter out of the body through the rectum.
A cecostomy may be needed for very severe constipation that is not responding to laxatives or other methods of relieving the bowels. If constipation is causing severe pain or other potential bodily harm, then your child’s doctor might recommend a cecostomy. Conditions that can lead to severe fecal incontinence that might require a cecostomy include:
An imperforate anus (the anus isn’t allowing material to pass properly)
Spinal abnormalities, such as spina bifida
A combination of the two above conditions
Other muscular conditions
Generally, fecal incontinence has to be quite severe and unresponsive to other treatments to require a cecostomy. Most children with fecal incontinence will respond to other methods of treatment that are not quite as invasive.
A cecostomy is generally well-tolerated. Still, the procedure does have some risks involved. These include:
An infection in the abdomen, known as peritonitis, caused by misplacing the catheter
Mechanical failure of the catheter
Growth of tissue at the catheter site
Bleeding and irritation at the catheter site
Skin infections and other infections around the insertion point for the catheter
Before the cecostomy tube can be inserted, a “bowel prep” must be completed to cleanse the colon.
The bowel preparation includes following a clear-fluid diet for two days before the procedure.
The night before the procedure, your child will likely need to drink an oral solution provided by the doctor. This is a laxative that is used to clean out the bowels.
On the day of the procedure, an abdominal X-ray will be used to ensure that the bowel is free of stool.
The cecostomy tube insertion procedure is one that requires a brief hospital stay, usually around one or two days. This is a general guideline of how the procedure will go:
Doctors will usually use IV sedation (relaxed while awake for the procedure) or a general anesthesia (asleep for the procedure) for cecostomy tube insertion.
Doctors usually inflate the colon with air until the cecum is distended.
The doctor inserts surgical tools through the skin and into the cecum and attaches the bowel to the abdominal wall with stitches, sutures, or fasteners.
The doctor inserts a special hollow needle into the cecum.
A catheter, or narrow tube, is threaded through this needle and into the cecum.
The process outlined above is what is required to insert the cecostomy tube. The process of a cecostomy itself will then be done occasionally to relieve the bowels based on individual needs.
Once the cecostomy tube has been inserted, your child usually will stay in the hospital until the next day for observation and to minimize the risks of complications. Your child may need to return to the doctor for a “contrast study.” To ensure that the catheter is placed properly, contrast dye is injected through the catheter and into the cecum. Then an X-ray is used to examine this dye and ensure that it travels into the cecum. Your child may also need to return for replacement of the original catheter tube.
The insertion of the cecostomy tube is just the first step in relieving fecal incontinence through the process of cecostomy. After about a week, you will actually administer antegrade enema through the cecostomy tube to your child at home, with guidance from your child’s doctor. This process will involve inserting liquid into the cecostomy tube, which will pass into the cecum to encourage a bowel movement. The frequency of the antegrade enemas through the cecostomy tube that you’ll need to perform will vary based on your child’s needs. Your child’s doctor should provide you with guidance in this area.
Notify your child’s doctor about any of the following:
A noticeable skin infection at the catheter site
Bleeding or swelling at the site
Pus leaking from the site
The catheter becomes dislodged or moves
For hygiene and to avoid the risk of complications, your child will likely need to have the catheter removed and replaced occasionally.