OP‐10 EFFICACY AND SAFETY OF ENEMAS ADMINISTERED HIGH IN THE RECTUM FOR FECAL DISIMPACTION IN CHILDREN.

Abstract

Aim:Efficacy and safety of enemas administered high in the rectum for fecal disimpaction in children was evaluated by a retrospective cohort study.Methods:Between January 1, 2012 and January 1, 2014 all procedures were evaluated. All enemas were administered, using a standardized in‐house protocol, so all procedures were performed in the same way. An enema high in the rectum was considered effective, if stool production exceeded the amount of stools that is regarded normal for the age and weight of the patient, and if the patient felt relieved after the production of stools.A qualitative scale was used by the nursing staff to estimate the amount of stools produced by the patient (‘none’, ‘little’, ‘normal’, ‘many’). Stool consistency was scored, using Bristol Stool Scale. Total stool production within 12 hours after enema was scored. Literature review was performed on efficacy and safety of enemas high in the rectum.Results:N = 77 procedures were evaluated in which all data were documented. Enemas were administered in N = 75 children (36 girls/39 boys: mean age: 9.8 yr (3.6 ‐ 19)(range)). Fecal impaction was present, defined as: palpable mass in abdomen or in rectum and a history of low stool frequency. N = 25 children were treated with more than one enema during the studied period. 68 % of enemas were effective for acute disimpaction. In 30 (45%) procedures, many stools were evacuated, in 15 (23%) procedures the amount was normal; in 18 (27%) procedures there was little stool production and in 3 (5%) procedures no stools were produced. In N = 11 procedures the amount of stools produced was documented insufficiently. Procedure‐ related complications were not seen. In literature no data were found on the efficacy or on safety of enemas administered high up in the rectum. Literature shows equal efficacy of high dose (oral) macrogol as compared to standard rectal enemas (not high up).Conclusions:Enemas administered high up in the rectum are safe in all, and effective in a majority of patients for the management of fecal impaction in children. Prospective studies are needed to evaluate efficacy of enemas high up in the rectum as compared to high doses of macrogol for fecal disimpaction in children.