Sigmoid irrigation tube for the management of chronic evacuation disorders

Background/Purpose: Antegrade colonic irrigation, in which the right colon is accessed via appendicostomy or cecostomy, now is an important adjunct in the management of children with chronic evacuation disorders. However, in most children, the major area of dysfunction is the left rather than the right colon. The authors developed a simple, percutaneous endoscopic, laparoscopically controlled sigmoid irrigation tube placement and evaluated the results in 4 children. Methods: A rigid sigmoidoscope is advanced into the upper sigmoid and the loop brought in contact with the abdominal wall under laparoscopic control. A small skin incision is made and a needle pushed across the abdominal and sigmoid walls into the lumen of the sigmoidoscope. A guide wire is advanced through the needle into the scope and retrieved. After the scope is removed, a PEG-type catheter is attached to the guide wire and pulled back, securing the sigmoid loop to the abdominal wall. The tube is subsequently converted to a skin-level device by simply adding an external port valve. Results: All 4 patients achieved prompt evacuation in the sitting position. Conclusions: Sigmoid tube for antegrade irrigation is an appealing alternative to conventional cecal access. The procedure is simple and may offer physiologic advantages. J Pediatr Surg 37:348-351. Copyright (C) 2002 by W.B. Saunders Company.