Pediatric Cecostomy Tube

Cecostomy is surgery to clear a child's bowels of feces when other treatment has not worked. It is used for children with fecal incontinence caused by major health problems. Fecal incontinence means your child can’t control his or her bowels. Symptoms can range from having severe constipation to having a bowel movement at an unexpected or embarrassing time.

Cecostomy is different from an enema that is used to ease constipation. An enema is given directly through the rectum to help free the feces. In a cecostomy, the healthcare provider puts a tube (catheter) into the first part of the large intestines (cecum). It is in the lower right abdomen. The provider injects liquid medicine into the cecum through this tube. The medicine helps coax the feces out of the body through the rectum.

Your child may need a cecostomy if he or she has fecal incontinence and other treatments have not worked. But most children with this health problem will have success with other treatments.

Your child may also need the procedure if he or she has any of the following:

• The anus isn’t letting feces pass as it should (imperforate anus)
• Spinal problems, such as spina bifida
• A combination of the above two health problems
• Other muscular problems

Most children don't have any problems with the procedure. But it does have some risks. These are:

• The tube (catheter) gets displaced
• An infection in the abdomen (peritonitis) caused by misplacing the catheter
• Mechanical failure of the tube
• Growth of tissue at the tube site
• Bleeding and irritation at the tube site
• An infection around the site where the tube was inserted

Getting ready for the procedure includes:

• Before the tube can be put in, your child may need a bowel prep to clean the colon.
• For the bowel prep, your child will have to be on a clear-fluid diet for two days before the cecostomy.
• The night before the procedure, your child will likely need to drink a laxative solution. It cleans out the bowels.
• On the day of the procedure, your child will have an abdominal X-ray to make sure the bowel is free of stool.

Your child will need to stay in the hospital for the procedure to insert the cecostomy tube. The stay often lasts 1 to 2 days. Most of the time, the procedure will go as follows:

• Your child will get medicine through an IV (intravenous) line that helps him or her relax during the procedure. Your child may be put to sleep with general anesthesia.
• A healthcare provider usually inflates the colon with air until the cecum is expanded.
• The healthcare provider puts surgical tools through small cuts (incisions) in the skin and into the cecum. He or she attaches the bowel to the abdominal wall with stitches, sutures or fasteners.
• The provider puts a special hollow needle into the cecum.
• The provider threads the catheter through this needle and into the cecum.

This procedure can also be done with a laparoscope. With this technique, the healthcare provider puts a laparoscope into a small incision in the belly button.

The process outlined above is what is done to insert the cecostomy tube. The cecostomy itself will then be done occasionally to relieve the bowels based on your child’s needs.

Once the cecostomy tube has been put in, your child will stay in the hospital until the next day for observation. This will help lower the risk for complications.

Your child may also need a contrast study. This test makes sure that the catheter is placed properly. For the test the healthcare provider injects contrast dye through the tube and into the cecum. Then the provider uses an X-ray to look at the dye to make sure that it travels into the cecum.

Putting the cecostomy tube in place is just the first step in easing 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 healthcare provider. 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 healthcare provider will tell you how often this will need to be done.

Tell your child’s healthcare provider if your child has any of the following:

• A noticeable skin infection at the catheter site
• Bleeding or swelling at the site
• Pus leaking from the site
• The tube becomes dislodged or moves
• Abdominal pain
• Fever

Your child will likely need to have the catheter removed and replaced from time to time. It will have to be done for hygiene reasons and to lower the risk for complications.