Home | About Us | Current Issue | Ahead of print | Archives | Search | Instructions | Subscription | Feedback | Editorial Board | e-Alerts | Login 
Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
 Users Online:73 
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size


 
Table of Contents   
LETTER TO THE EDITOR
Year : 2013  |  Volume : 18  |  Issue : 4  |  Page : 166-167
 

Bowel perforation due to retained enema nozzle in a patient of anorectal malformation


Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India

Date of Web Publication8-Nov-2013

Correspondence Address:
Abhilasha Tej Handu
Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bangalore - 560 029, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.121124

Rights and Permissions

 



How to cite this article:
Handu AT, Aravind K L, Gowrishankar B C, Ramesh S. Bowel perforation due to retained enema nozzle in a patient of anorectal malformation. J Indian Assoc Pediatr Surg 2013;18:166-7

How to cite this URL:
Handu AT, Aravind K L, Gowrishankar B C, Ramesh S. Bowel perforation due to retained enema nozzle in a patient of anorectal malformation. J Indian Assoc Pediatr Surg [serial online] 2013 [cited 2019 Nov 17];18:166-7. Available from: http://www.jiaps.com/text.asp?2013/18/4/166/121124


Sir,

Bowel management using colonic washouts is frequently practiced in children with fecal incontinence. Pena et al have described algorithms for management of such children and have reported success rates of more than 95%. [1],[2] We too have successfully initiated the bowel management program in many of our patients. Although it is generally a safe procedure, we encountered a case of a sigmoid perforation due to bowel washes in a child with anorectal malformation. Although this complication has been seen in peripheral hospitals due to enema nozzles and rectal thermometers, retention of enema nozzle has not been reported in the setting of bowel management in the available literature.

A 5-year-old boy who had completed 3-stage management of high anorectal malformation was started on bowel washes for management of fecal incontinence. A plastic enema can that is routinely available was used. The can has a detachable plastic tubing and two different sizes of plastic nozzles which can be attached to the plastic tubing ([Figure 1]- inset). About 2 months after initiation of washes the child presented to the emergency room with abdominal distension, feculent vomiting, and constipation. Clinical examination showed features of peritonitis. Erect X-ray abdomen showed gas under diaphragm. The child was resuscitated and taken up for exploratory laparotomy.
Figure 1: Sigmoid perforation due to enema nozzle (Inset - Enema can with plastic tubing and 2 nozzles)

Click here to view


On exploration, there was a perforation in the sigmoid colon about 5 cm from the peritoneal reflection [Figure 1]. The enema nozzle was seen to be jutting out of the perforation. Primary closure of the perforation was performed after removing the foreign body. Post-operative recovery was uneventful and the child was sent home on the 7 th post-operative day.

Bowel wash for management of pediatric fecal incontinence can be mastered easily by parents under the guidance of a doctor or a trained nurse. Complications such as hypernatremia due to excessive use of salt in enema fluid and colitis due to use of phosphate enemas have been mentioned by Bischoff et al in their experience. [1] However, mechanical complication due to accidental retention of the enema nozzle has not been reported.

In order to prevent this complication, a long red rubber catheter or a Foley's catheter may be used to administer the enema. This is also recommended by Bischoff et al. [3] These have the added advantage of preventing leakage of the enema fluid. Accidental breakage and retention may still be a possibility.

Bowel management has changed the lives of many children with fecal incontinence. Although it is a safe and easy procedure, detailed instructions to the parents and spending time to explain the procedure may be beneficial to avoid such problems in the future. Careful vigilance on the part of the caregiver also needs to be highlighted to avoid such a complication.

 
   References Top

1.Bischoff A, Levitt MA, Bauer C, Jackson L, Holder M, Peña A. Treatment of fecal incontinence with a comprehensive bowel management program. J Pediatr Surg 2009;44:1278-84.  Back to cited text no. 1
    
2.Bischoff A, Tovilla M. A practical approach to the management of pediatric fecal incontinence. Semin Pediatr Surg 2010;19:154-9.  Back to cited text no. 2
    
3.Bischoff A, Levitt MA, Pena A. Bowel management for the treatment of pediatric fecal incontinence. Pediatr Surg Int 2009;25:1027-42.  Back to cited text no. 3
    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article

    

 
  Search
 
  
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (477 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed2399    
    Printed31    
    Emailed0    
    PDF Downloaded75    
    Comments [Add]    

Recommend this journal


Contact us | Sitemap | Advertise | What's New | Copyright and Disclaimer 

  2005 - Journal of Indian Association of Pediatric Surgeons | Published by Wolters Kluwer - Medknow 

Online since 1st May '05