The presence of bowel contents during colorectal surgery has been related to surgical site infections (SSI), anastomotic leakage (AL) and postoperative complications theologically. Mechanical bowel preparation (MBP) for elective colorectal surgery aims to reduce fecal materials and bacterial count with the objective to decrease SSI rate, including AL. Based on many observational data, meta-analysis and multicenter randomized control trials (RTC), non-MBP did not increase AL rates or SSI and other complications in colon and even rectal surgery. In 2011 Cochrane review, there is no significant benefit MBP compared with non-MBP in colon surgery and also no better benefit MBP compared with rectal enemas in rectal surgery. However, in surgeon's perspectives, MBP is still in widespread surgical practice, despite the discomfort caused in patients, and general targeting of the colon microflora with antibiotics continues to gain popularity despite the lack of understanding of the role of the microbiome in anastomotic healing. Recently, there are many evidence suggesting that MBP+oral antibiotics (OA) should be the growing gold standard for colorectal surgery. However, there are rare RCT studies and still no solid evidences in OA preparation, so further studies need results in both MBP and OA and only OA for colorectal surgery. Also, MBP studies in patients with having minimally invasive surgery (MIS; laparoscopic or robotics) colorectal surgery are still warranted. Further RCT on patients having elective left side colon and rectal surgery with primary anastomosis in whom sphincter saving surgery without MBP in these MIS and microbiome era.
Anastomotic Leak ; Anti-Bacterial Agents ; Bacterial Load ; Colon ; Colorectal Surgery ; Enema ; Humans ; Microbiota ; Minimally Invasive Surgical Procedures ; Postoperative Complications ; Surgical Wound Infection

Pain therapy often entails gastrointestinal adverse events. While opioids are effective drugs for pain relief, the incidence of opioid-induced constipation (OIC) varies greatly from 15% to as high as 81%. This can lead to a significant impairment in quality of life, often resulting in discontinuation of opioid therapy. In this regard, a good doctor-patient relationship is especially pivotal when initiating opioid therapy. In addition to a detailed history of bowel habits, patient education regarding the possible gastrointestinal side effects of the drugs is crucial. In addition, the bowel function must be regularly evaluated for the entire duration of treatment with opioids. Furthermore, if the patient has preexisting constipation that is well under control, continuation of that treatment is important. In the absence of such history, general recommendations should include sufficient fluid intake, physical activity, and regular intake of dietary fiber. In patients of OIC with ongoing opioid therapy, the necessity of opioid use should be critically reevaluated in terms of an with acceptable quality of life, particularly in cases of non-cancer pain. If opioids must be continued, lowering the dose may help, as well as changing the type of opioid. If these measures do not suffice, the next step for persistent OIC is the administration of laxatives. If these are ineffective as well, treatment with peripherally active μ-opioid receptor antagonists should be considered. Enemas and irrigation are emergency measures, often used as a last resort.
Analgesics, Opioid ; Constipation ; Dietary Fiber ; Emergencies ; Enema ; Health Resorts ; Humans ; Incidence ; Laxatives ; Motor Activity ; Narcotic Antagonists ; Pain Management ; Patient Education as Topic ; Pharmaceutical Preparations ; Quality of Life

PURPOSE: The aims of this study were to identify the clinical characteristics of an anastomotic sinus and to assess the validity of delaying stoma closure in patients until the complete resolution of an anastomotic sinus. METHODS: The subject patients are those who had undergone a resection of rectal cancer from 2011 to 2017, who had a diversion ileostomy protectively or therapeutically and who developed a sinus as a sequelae of anastomotic leakage. The primary outcomes that were measured were the incidence, management and outcomes of an anastomotic sinus. RESULTS: Of the 876 patients who had undergone a low anterior resection, 14 (1.6%) were found to have had an anastomotic sinus on sigmoidoscopy or a gastrografin enema before their ileostomy closure. In the 14 patients with a sinus, 7 underwent ileostomy closure as scheduled, with a mean closure time of 4.1 months. The remaining 7 patients underwent ileostomy repair, but it was delayed until after the follow-up for the widening of the sinus opening by using digital dilation, with a mean closure time of 6.9 months. Four of those remaining seven patients underwent stoma closure even though their sinus condition had not yet been completely resolved. No pelvic septic complications occurred after closure in any of the 14 patients with an anastomotic sinus, but 2 of the 14 needed a rediversion due to a severe anastomotic stricture. CONCLUSION: Patients with an anastomotic sinus who had been carefully selected underwent successful ileostomy closure without delay.
Anastomotic Leak ; Constriction, Pathologic ; Diatrizoate Meglumine ; Enema ; Follow-Up Studies ; Humans ; Ileostomy ; Incidence ; Rectal Neoplasms ; Sigmoidoscopy

BACKGROUND: This study aimed to investigate the awareness and application of ROME IV criteria for functional constipation (FC) in real-world practices and assessed differences between pediatric gastroenterologists (PGs) and general pediatricians. METHODS: A total of 239 (47.8%) out of 500 nationwide pediatricians answered a questionnaire for diagnosis and management of pediatric FC; 60 were PGs (75% of total PGs in Korea). RESULTS: A total of 16.6% of pediatricians were aware of the exact ROME IV criteria. Perianal examination and digital rectal examination were practiced less, with a higher tendency among PGs (P < 0.001). Treatment duration was longer among PGs for > 6 months (63.8%) than < 3 months among general pediatricians (59.2%, P < 0.001). Fecal disimpaction and rectal enema were practiced among 78.8% and 58.5% of pediatricians, respectively. High dose medication for initial treatment phase was prescribed by 70.7% of pediatricians, primarily within the first 2 weeks (48.3%). The most commonly prescribed medications in children aged > 1-year were lactulose (59.1%), followed by polyethylene glycol (PEG) 4000 (17.7%), and probiotics (11.8%). Prescription priority significantly differed between PGs and general pediatricians; lactulose or PEG 4000 were most commonly prescribed by PGs (89.7%), and lactulose or probiotics (75.7%) were prescribed by general pediatricians (P < 0.001). For patients aged < 1-year, lactulose (41.6%) and changing formula (31.7%) were commonly prescribed. Most participants recommended diet modification, and PGs more frequently used defecation diary (P = 0.002). CONCLUSION: Discrepancies between actual practice and Rome IV criteria and between PGs and general pediatricians were observed. This survey may help construct practice guidelines and educational programs for pediatric FC.
Child ; Colonic Diseases, Functional ; Constipation ; Defecation ; Diagnosis ; Digital Rectal Examination ; Enema ; Food Habits ; Humans ; Lactulose ; Polyethylene Glycols ; Prescriptions ; Probiotics

STUDY DESIGN: Case report. OBJECTIVES: We report a case of Ogilvie's syndrome following posterior decompression surgery in a spinal stenosis patient who presented with acute abdominal distension, nausea, and vomiting. SUMMARY OF LITERATURE REVIEW: Ogilvie's syndrome is a rare and potentially fatal disease that can easily be mistaken for postoperative ileus, and is also known as acute colonic pseudo-obstruction. Early recognition and diagnosis enable treatment prior to bowel perforation and requisite abdominal surgery. MATERIALS AND METHODS: An 82-year-old woman presented with 6 months of worsening back pain with walking intolerance due to weakness in both legs. She had hypertension, asthma, and Cushing syndrome without bowel or bladder symptoms. Further workup demonstrated the presence of central spinal stenosis on magnetic resonance imaging. The patient underwent an L2-3 laminectomy and posterior decompression. Surgery was uneventful. RESULTS: The patient presented with acute abdominal distension, nausea, and vomiting on postoperative day 1. The patient was initially diagnosed with adynamic ileus and treated conservatively with bowel rest, reduction in narcotic dosage, and a regimen of stool softeners, laxatives, and enemas. Despite this treatment, her clinical course failed to improve, and she demonstrated significant colonic distension radiographically. Intravenous neostigmine was administered as a bolus with a rapid and dramatic response. CONCLUSION: Ogilvie's syndrome should be included in the differential diagnosis of postoperative ileus in patients developing prolonged unexplained abdominal distension and pain after lumbar spinal surgery. Early diagnosis and initiation of conservative management can prevent major morbidity and mortality due to bowel ischemia and perforation.
Aged, 80 and over ; Asthma ; Back Pain ; Colon ; Colonic Pseudo-Obstruction ; Cushing Syndrome ; Decompression ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Enema ; Female ; Humans ; Hypertension ; Ileus ; Ischemia ; Laminectomy ; Laxatives ; Leg ; Magnetic Resonance Imaging ; Mortality ; Nausea ; Neostigmine ; Spinal Stenosis ; Urinary Bladder ; Vomiting ; Walking

To evaluate the therapeutic effect of traditional Chinese medicine( TCM) retention enema in treating ulcerative colitis( UC) by Meta-analysis method. Randomized controlled trials( RCTs) of TCM retention enema in treatment of UC were retrieved from databases as CNKI,Wan Fang,CBM,VIP and PubMed from inception to June 2019. The quality of RCTs was assessed by using the Cochrane collaboration's tool for assessing risk of bias,Meta-analysis were performed with Rev Man 5. 3 software and publication bias was tested by using Stata 15. 1 software. There were twenty-eight articles enrolled,and 2 477 patients were included. The result of Meta-analysis showed that retention enema with TCM had significantly better effectiveness in overall curative effect( RR_SASP= 1. 18,95%CI[1. 13,1. 22],Z = 8. 32,P < 0. 01; RR_5-ASA= 1. 13,95% CI[1. 03,1. 21],Z = 2. 61,P < 0. 01) symptom curative effect( RR =1. 44,95%CI[1. 22,1. 71],Z = 4. 25,P<0. 01) than those of the control group,and the treatment group was lower than the control group in terms of recurrence( RR = 0. 31,95% CI[0. 17,0. 56],Z = 3. 88,P< 0. 01) and adverse events( RR = 0. 38,95% CI[0. 18,0. 78],Z = 2. 64,P<0. 01),with statistically significant differences. However,there was no significant difference in Meta-analysis result of colonoscopic mucosal change between the two groups. TCM enema is an effective method to treat ulcerative colitis.
Colitis, Ulcerative ; Drugs, Chinese Herbal ; Enema ; Humans ; Male ; Medicine, Chinese Traditional

Drug retention enema is a common therapy for various illnesses. However, it is impossible to keep the drug in the colon for a long time, due to the limitation of the current equipment, and it is unable to achieve the purpose of retention enema. A retention enema device was designed by the department of intensive care unit (ICU) of Dongfeng Hospital Affiliated to Hubei University of Medicine. The retention enema device adds a spindle shaped inflatable air bag on the basis of the traditional enema device, which not only fix on the anus, but also prevent the leakage of enema fluid. It can achieve retention enema, play the enema drug effect fully, and significantly reduce the nursing workload, in addition, the silica gel material of the retention enema device ensures the comfort of the patients, the decompression air bag also avoids the damage of the high pressure of the spindle fixed air bag for the patients, which is worthy of clinical use.
Colon ; Enema/instrumentation* ; Humans

PURPOSE: Meconium-related ileus is common in preterm infants. Without proper management, it can cause necrotizing enterocolitis and perforation requiring emergent operation. This study was conducted to describe the efficacy and safety of ultrasound-guided Gastrografin enema at bedside for preterm infants with meconium-related ileus. METHODS: Between March 2013 and December 2014, this study enrolled preterm infants with birth weight < 1,500 g, who were diagnosed with meconium-related ileus requiring ultrasound-guided Gastrografin enema refractory to glycerin or warm saline enemas. Gastrografin was infused until it passed the ileocecal valve with ultrasound guidance at bedside. RESULTS: A total of 13 preterm infants were enrolled. Gestational age and birth weight were 28.6 weeks (range, 23.9–34.3 weeks) and 893 g (range, 610–1,440 g), respectively. Gastrografin enema was performed around postnatal day 8 (range, day 3–11). The success rate was 84.6% (11 of 13 cases). Three of these 11 infants received a second procedure, which was successful. Among 2 unsuccessful cases, one failed to pass meconium while the other required surgery due to perforation. The time required to pass meconium was 2.8±1.5 hours (range, 1–6 hours). The time until radiographic improvement was 2.8±3.4 days (range, 1–14 days) after the procedure. CONCLUSION: Ultrasound-guided Gastrografin enema at bedside as a first-line treatment to relieve meconium-related ileus was effective and safe for very low birth weight infants. We could avoid unnecessary emergent operation in preterm infants who have high postoperative morbidity and mortality. This could also avoid transporting small preterm infants to fluoroscopy suite.
Birth Weight ; Diatrizoate Meglumine ; Enema ; Enterocolitis, Necrotizing ; Fluoroscopy ; Gestational Age ; Glycerol ; Humans ; Ileocecal Valve ; Ileus ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Meconium ; Mortality ; Ultrasonography

PURPOSE: Barium enema is one of the diagnostic modalities for Hirschsprung'sdisease. The present study aimed to investigate the diagnostic accuracy of barium enema for Hirschsprung's disease, especially total colonic aganglionosis (TCA). METHODS: We retrospectively reviewed the medical records of all the patients who were diagnosed as having TCA and underwent a barium enema in Asan Medical Center Children's Hospital between January 1998 and December 2016. All the tests were performed and reviewed by pediatric radiologists. RESULTS: Among the total 19 patients with TCA who underwent barium enema, 9 patients (47.4%) had accurate radiographic results. Eight of the 13 neonate patients (61.5%) showed typical TCA radiological findings. However, only one of the 6 patients aged >4 weeks (16.7%) had accurate radiological diagnosis. CONCLUSION: Barium enema showed low accuracy for TCA, and its diagnostic performance was better in neonatal period than in those aged >4 weeks.
Barium ; Chungcheongnam-do ; Diagnosis ; Enema ; Hirschsprung Disease ; Humans ; Infant, Newborn ; Medical Records ; Retrospective Studies

This paper presents a case report of tension pneumoperitoneum that occurred in a 4-month-old girl with intussusception during pneumatic reduction. Tension pneumoperitoneum is a rare but life threatening complication in air pressure enema that is commonly used to turn the intussuscepted bowel to its original position. The incidence of a simple pneumoperitoneum due to a bowel perforation associated with attempted pneumatic reduction for intussusception is as high as 4%. The simple pneumoperitoneum changed rapidly to tension pneumoperitoneum and immediate needle decompression was life-saving in this case. Similar to a tension pneumothorax, the diagnosis is clinical and management should not be delayed awaiting other confirmatory tests. The emergency physician must recognize this rare complication of pneumatic reduction and promptly treat the ensuing tension pneumoperitoneum after bowel perforation with immediate needle decompression as a part of the initial resuscitation.
Air Pressure ; Decompression ; Diagnosis ; Emergencies ; Enema ; Female ; Humans ; Incidence ; Infant ; Intussusception* ; Needles ; Pneumoperitoneum* ; Pneumothorax ; Resuscitation