[Antegrade colonic enema is a choice for the treatment of faecal incontinence and constipation].

UNLABELLED: Faecal incontinence and constipation cannot always be treated successfully by conservative or surgical methods. In these cases regular retrograde colonic enema can reduce the symptoms of the patients and can establish pseudocontinence. The authors present a method of colon cleaning which has been used successfully. The method was introduced in clinical practice by Malone in 1990. The antegrade enema is administered through the appendicostomy. In cases, where the appendectomy was performed earlier, a neoappendix was created from the coecal wall and used for the irrigation of the colon. During procedure the patients injected tap water (300-450 ml) through the (neo-)appendicostomy with a thin catheter. After a short time period this was followed by passing of the stool. The procedure was performed on twelve patients, five female, and seven male patients (mean age: 39.2 years). The indications for the procedure were the following: faecal incontinence induced by denervation of the pelvic floor in three patients, sphincter trauma in two patients and congenital sphincter malformation in two cases. In addition, combined symptoms of faecal incontinence and constipation caused by pelvic floor denervation in three patients. Finally, intractable constipation was the reason in two patients. After irrigation, the stool was passed, but the functional result was rather variable. Eight out of twelve patients were satisfied with the result, two patients reported improvement in the constipation, but it failed in one case. In another case, the appendicostomy could not have been used due to surgical complications. The stricture of the (neo-)appendicostomy was observed in two cases. Significant reflux occurred only in one case.

CONCLUSION: after adequate patient selection this method can be applied with success.