Mucosal Colonic Tube (Mct) For Antegrade Colonic Lavage In Urological Patients

Abstract

PURPOSE Faecal impaction and incontinence are often part of the symptom complex in many paediatric urological patients with severe anomalies. Antegrade enemas through an appendicostomy are sometimes required. Should the appendix be absent or utilized for another purpose then a chait tube or caecostomy button can provide colonic access. However these devices may be associated with breakages, accidental removal and, leakage.Replacement may require a general anaesthetic. Full thickness colonic tubes can also be constructed but are associated with leakage of both gas and faecal material. The construction of a mucosal colonic tube with antireflux wrap avoids the above problems and is advantageous in urological patients. MATERIAL AND METHODS Six children (4 spinabifida) were selected Technique At variable sites in the colon a small full thickness rectangular flap is opened and swung laterally. The mucosa alone is sutured to form a tube which is fundoplicated at its base by adjacent colon and brought to the skin to create a fistula. RESULTS The effectiveness was evaluated using a modified quality of life score(QOLI). The score assessed soiling, staining, odour, self esteem and socialization. The ease of catheterization and continence of the mucosal fistula site was assessed. Follow up : Median 62 months Range (19 – 68) QOLI scores improved from 4.75 to 18.5 Possible range(0 – 21) All fistula sites catheterize easily with no stenosis or faecal leakage. Two patients required treatment for minor skin granulations. Despite the small numbers of patients the follow up has been for a considerable period with all stable on their catheterization with excellent faecal continence. CONCLUSIONS The mucosal colonic tube is a new technique that provides excellent access to the colon for a group of previously difficult urological patients.