[size=20px]A six-year old boy had repair of imperforate anus with rectobladder fistula as an infant. He has experienced persistent fecal incontinence despite adjustments in his laxative and enema regimens. An antegrade continent stoma is recommended.

 

In advising the parents, which complication of an antegrade continent stoma that would require surgical intervention is most likely to occur ?

 

A failure to resolve incontinence

 

B stoma prolapse

 

C stoma leak

 

D stomal stricture

 

E parastomal herniation[/size]

(Untitled)

 

d

d

correct

 

The antegrade continent enema (ACE) procedure is designed to provide a continent conduit to the cecum for antegrade enemas. Such enemas can be helpful in allowing daily bowel cleanout for patients with significant compromise of anorectal function. Typical candidates in the pediatric population include those who have had reconstruction for anorectal malformations, pull through for Hirschsprung disease and refractory functional constipation. The appendix is typically used as a conduit and may or may not be plicated. The umbilicus is a common site to place such a stoma although the right lower quadrant of the abdomen may be used as well. The most frequent complication of an ACE stoma is stricture with rates of 8-40%. This also accounts for the most surgical revisions. Other surgcial complications include prolapse, leak and parastomal herniation.

 

A stricture may be managed nonoperatively by more frequent catheterizations, triamcinilone cream, dilation of the stricture under sedation/anesthesia and placement of an access button or a plug. Surgical revision is often required, however. Rangel describes a V-V umbilicoplasty as one method of reducing or managing strictures.