COLONIC EMPTYING AFTER A NEW TRANSANAL IRRIGATION SYSTEM IN PATIENTS WITH SPINAL CORD INJURY Objective: Segmental delays in colonic transit are present and evacuation is incomplete in patients with SCI. Our aim is to evaluate if a new method for colonic washout (Peristeen; Coloplast-Denmark) was able to induce evacuation of the retained radiopaque markers in patients with SCI with severely delayed intestinal transit time. Design: A single abdominal x-ray film was obtained after daily ingestion of 10 radiopaque pellets for 6 days, during which number of bowel movements was evaluated by a diary. Then transanal irrigation (TAI) was performed by a device equipped with an enema continence catheter fit for an 800-ml. infusion of tap water in 8 minutes allowed by a constant positive pressure inside the system. A second x-ray was performed immediately after patient evacuation. Participants/Methods: Twelve patients with difficult evacuation (8 men, 4 tetraplegic and 4 paraplegic, mean age 36 ± 13 years, range: 26 to 64 years) all with ASIA score A except 2 with paraplegia, underwent the intestinal Transit Study and TAI procedure. Radio-opaque markers that were present in the right, in the left and in the rectosigmoid tract were numbered before and after the unique session of colonic washout. Intestinal transit time was calculated according to the method of Abrahamsson (Scand J Gastroenterol, 1988; 152:72-80). Results: The average total intestinal transit time was 5.2 ± 1.1 days (range, 3.5-6.5 days), in relationship to 2.3 ± 1.1 evacuations (range, 1-4 days), which occurred during the study period; 13.6 ± 9.3, 10.6 ± 7, and 22.8 ± 16 markers were in the right, left, and rectosigmoid tract, respectively. After TAI-induced defecation, 10.5 ± 10.3, 1.5 ± 1.6, and 5 ± 3.5 markers were still located in the 3 colonic segments, respectively. Comparison shows a statistical significant (t test for paired data) decrease in the left and rectosigmoid tract (p ‹ 0.03). Conclusion: This study confirms that constipation in patients with SCI is related to a very slow colonic transit. In these patients, defecation is incomplete because there is a discrepancy between number of markers retained and bowel motion frequency. Retrograde colonic irrigation by means of Peristeen is effective for inducing a complete emptying of the left colon and rectosigmoid tract.
BAZZOCCHI G., POLETTI E., PILLASTRINI P., MENARINI M. (2006). Colonic Emptying after a new Trans Anal Irrigation system in patients with Spinal Cord Injury. s.l : s.n.
Colonic Emptying after a new Trans Anal Irrigation system in patients with Spinal Cord Injury
BAZZOCCHI, GABRIELE;PILLASTRINI, PAOLO;MENARINI, MAURO
2006
Abstract
COLONIC EMPTYING AFTER A NEW TRANSANAL IRRIGATION SYSTEM IN PATIENTS WITH SPINAL CORD INJURY Objective: Segmental delays in colonic transit are present and evacuation is incomplete in patients with SCI. Our aim is to evaluate if a new method for colonic washout (Peristeen; Coloplast-Denmark) was able to induce evacuation of the retained radiopaque markers in patients with SCI with severely delayed intestinal transit time. Design: A single abdominal x-ray film was obtained after daily ingestion of 10 radiopaque pellets for 6 days, during which number of bowel movements was evaluated by a diary. Then transanal irrigation (TAI) was performed by a device equipped with an enema continence catheter fit for an 800-ml. infusion of tap water in 8 minutes allowed by a constant positive pressure inside the system. A second x-ray was performed immediately after patient evacuation. Participants/Methods: Twelve patients with difficult evacuation (8 men, 4 tetraplegic and 4 paraplegic, mean age 36 ± 13 years, range: 26 to 64 years) all with ASIA score A except 2 with paraplegia, underwent the intestinal Transit Study and TAI procedure. Radio-opaque markers that were present in the right, in the left and in the rectosigmoid tract were numbered before and after the unique session of colonic washout. Intestinal transit time was calculated according to the method of Abrahamsson (Scand J Gastroenterol, 1988; 152:72-80). Results: The average total intestinal transit time was 5.2 ± 1.1 days (range, 3.5-6.5 days), in relationship to 2.3 ± 1.1 evacuations (range, 1-4 days), which occurred during the study period; 13.6 ± 9.3, 10.6 ± 7, and 22.8 ± 16 markers were in the right, left, and rectosigmoid tract, respectively. After TAI-induced defecation, 10.5 ± 10.3, 1.5 ± 1.6, and 5 ± 3.5 markers were still located in the 3 colonic segments, respectively. Comparison shows a statistical significant (t test for paired data) decrease in the left and rectosigmoid tract (p ‹ 0.03). Conclusion: This study confirms that constipation in patients with SCI is related to a very slow colonic transit. In these patients, defecation is incomplete because there is a discrepancy between number of markers retained and bowel motion frequency. Retrograde colonic irrigation by means of Peristeen is effective for inducing a complete emptying of the left colon and rectosigmoid tract.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
