Cecostomy is a surgery to clear the bowels of feces. It is used for children with fecal incontinence due to severe health problems. Fecal incontinence is being unable to control your bowels. This can involve symptoms ranging from severe constipation to having a bowel movement at an unexpected or embarrassing time.
Children with this problem often have severe constipation. In some cases, liquid feces passes around the solid feces. It can leak out which can be embarrassing and frustrating for the child.
Cecostomy is slightly different from the traditional enema that is used to relieve constipation. An enema is given directly through the rectum to help release the feces.
In the cecostomy, a tube (catheter) is used for the procedure. This tube is inserted into the cecum. This is the first portion of the bowel or large intestines. It is located in the lower right abdomen. Liquid medicine is injected into the cecum through this tube. This helps coax the feces out of the body through the rectum.
Reasons for the procedure
Generally, fecal incontinence would have to be very severe and not responding to other treatments to require a cecostomy. Most children with this problem will have success with other less invasive types of treatment.
The procedure may be needed if your child has any of the following:
The anus isn’t allowing feces to pass properly (an imperforate anus)
Spinal problems, such as spina bifida
A combination of the two above health problems
Other muscular problems
Risks of the procedure
Most children do not have any problems with the procedure. However, it does have some risks. These include:
Catheter getting displaced
An infection in the abdomen (peritonitis) caused by misplacing the catheter
Mechanical failure of the catheter
Growth of tissue at the catheter site
Bleeding and irritation at the catheter site
Skin infections and other infections around the insertion point for the catheter
Before the procedure
Getting ready for the procedure includes the following:
Before the cecostomy tube can be inserted, a bowel prep may be done to clean the colon.
The bowel prep includes following a clear-fluid diet for two days before the procedure.
The night before the procedure, your child will likely need to drink a solution provided by the healthcare provider. This is a laxative used to clean out the bowels.
On the day of the procedure, an abdominal X-ray will be used to make sure the bowel is free of stool.
During the procedure
Your child will need to stay in the hospital for the procedure to insert the cecostomy tube. The stay usually lasts around one or two days. In general, the procedure will go as follows:
Doctors will usually use IV sedation (relaxed while awake for the procedure) or a general anesthesia (asleep for the procedure) for cecostomy tube insertion.
Doctors usually inflate the colon with air until the cecum is distended.
The doctor puts surgical tools through the skin and into the cecum and attaches the bowel to the abdominal wall with stitches, sutures, or fasteners.
The doctor inserts a special hollow needle into the cecum.
A catheter, or narrow tube, is threaded through this needle and into the cecum.
This procedure can also be done with a laparoscope. With this technique, the doctor puts a laparoscope into the belly button.
The process outlined above is what is done to insert the cecostomy tube. The process of a cecostomy itself will then be done occasionally to relieve the bowels based on your child’s needs.
After the procedure
Once the cecostomy tube has been put in, your child will stay in the hospital until the next day for observation. This will help lessen the risk of complications. Your child may need to go back to the doctor for a “contrast study” to make sure that the catheter is placed properly. For this test, contrast dye is injected through the catheter and into the cecum. Then an X-ray is used to examine this dye and make sure that it travels into the cecum. Your child may also need to return for replacement of the original catheter tube.
The insertion of the cecostomy tube is just the first step in relieving fecal incontinence. After about a week, you will give your child an enema through the cecostomy tube at home, with guidance from your child’s doctor. This process will involve putting liquid into the cecostomy tube. This liquid will pass into the cecum to encourage a bowel movement. Your child’s doctor will tell you how often this will need to be done.
Tell your child’s healthcare provider about any of the following:
A noticeable skin infection at the catheter site
Bleeding or swelling at the site
Pus leaking from the site
The catheter becomes dislodged or moves
Your child will likely need to have the catheter removed and replaced occasionally. This will have to be done for hygiene reasons and to avoid the risk of complications.