What is a cecostomy tube?
A cecostomy tube is used for those with stool incontinence, i.e. those with imperforate anus, spinal abnormalities, and some muscular disorders. Stool incontinence can range from severe constipation to having an unexpected or uncontrollable bowel movement. The tube is surgically inserted into the cecum, the first part of the large intestine and helps clean the bowel of stool by providing access to the beginning of the large intestine to wash it out with saline (salt solution).
What will happen in the hospital?
Children requiring cecostomy tubes are usually admitted the day before surgery and started on a bowel prep to clean out the colon. After surgery, the child is admitted to the pediatric surgical unit. Children usually remain on clear liquids until normal bowel function is returned. This is usually the first or second day after the surgery.
When will my child be discharged?
- After the child is tolerating a diet without nausea and vomiting.
- Teaching, regarding the cecostomy tube, has been done and family feels comfortable being discharged.
What will be my child's recovery?
- Your child may complain of some discomfort at the insertion site. Tylenol is allowed to relieve the discomfort. He or he may resume normal activities as tolerated. The doctor may also suggest a proper bowel cleansing regimen for the first week after placement of the cecostomy tube. It is ok to resume the same stool softeners that he or she was taking prior to surgery. You and your child will return for a postoperative visit one week after placement of the cecostomy tube. On that day, a dye study will be performed to assess the function of the cecostomy tube. If this test shows good function of the tube you will be able to start the antegrade enemas at home that day. We will arrange a visiting nurse to meet you at home that day to start the first enema that day.
- Most families find the best time to administer the enema at night after dinner. You and your child should commit 30 – 60 minutes to the antegrade enema and allow the enema to work to clean out the large intestine. The enema begins with the infusion of the prescribed amount of saline. This ranges from 600 – 1200 milliliters (approximately a quart) which is infused over 10 – 20 minutes. After this, your child should remain on the toilet to allow all of the saline to come out so as to avoid soiling during sleep.
- During your subsequent follow-up the volume of the enema can be adjusted to obtain the best outcome.
What should I be looking out for after the operation?
- Excessive soiling
- The cecostomy tube site may remain tender for a few days.
- After the operation it is important to look out for fevers, signs of infection, abdominal pain, catheter dislodgement, and granulation tissue (growth of tissue at or around the catheter site). If your child should experience abdominal cramping or nausea during the enemas, slow down the rate of the infusion. Severe pain may indicate tube dislodgement.
- If your child’s chait tube becomes dislodged, it should be replaced within 24 hours. Replacement is usually done in the operating room or interventional radiology. Often times, this is followed by a contrast study to ensure correct placement.