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Per rectum: a history of enemata.

Enemas and clysters have been administered since before recorded history, using instruments ranging from cow horns and hollowed out bamboo shoots to metal syringes to inject laxatives, herbs, opium, turpentine, tobacco, oxygen and noxious chemicals. The potentially lethal dangers are today well recognised. The rectal route, now less often used for laxative enemas is still proving useful for other medications, increasingly in suppository form.

Administration, Rectal↗

Herbal enemata.

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Enema↗

[Radiation risks and gonadal exposure in radiodiagnosis (author's transl)].

Radiation risk is estimated from the values on radiation risk of the International Council on Radiation Protection and from our own measurements. According to these, 1 malignant growth induced by radiation is found in about 160,000 urograms, 300,000 contrast enemata or 500,000 contrast meals. In radiodiagnosis of the central nervous system the values for carotid angiograms is about 60,000, for vertebral angiograms about 16,000, for computer tomography about 50,000 and about 500,000 examinations of the skull in two planes. A mutation-induced deformity due to radiation occurs in about 4,300--26,000 colon contrast enemata, about 43,000 to 280,000 contrast meals and about 41,000 respectively 14,000 urograms in men and women in the reproductive years.

Abnormalities, Radiation-Induced↗

Prescribing requirements of the elderly mentally handicapped: future demands on primary health care teams.

The medication prescribed for 269 mentally handicapped hospital residents aged 60 years and over on 1 January 1987, including five with Down's syndrome, and for 31 residents aged 50 years or over with Down's syndrome was analysed.Fifty of the 269 elderly residents were receiving no medication but the mean number of prescriptions for the remaining 219 was four. Of the total sample of 269 residents, 32% were taking drugs for psychiatric and psychological disorders; 11% regular antiepileptic drugs; 62% long-term drugs for other problems (diuretics and laxatives were the most common); 29% had long-term prescriptions for topical preparations, enemata or suppositories; 23% were on shortterm prescriptions for other problems; and 17% had short-term prescriptions for topical preparations, enemata or suppositories. For the 31 Down's syndrome residents the commonest prescriptions were for skin preparations.Particular care is needed in making a diagnosis and monitoring the effects of treatment on mentally handicapped patients because a complete history and full cooperation on examination may not be forthcoming. These findings have implications for primary health care teams who will be responsible for the mentally handicapped when hospitals close and the residents live in the community.

Aged↗

Meconium ileus--is a single surgical procedure adequate?

Meconium ileus is one of the gastrointestinal manifestations of cystic fibrosis (CF), and affects 15% of neonates. The condition results from the accumulation of sticky inspissated meconium. Both nonoperative and operative therapies may be effective in relieving obstruction. The treatment of choice for uncomplicated meconium ileus is the use of enteral N-acetylcysteine or Gastrografin enemata. Once such therapy fails, surgery is indicated. A number of operative procedures are in use, including Bishop-Koop enterostomy, T-tube irrigation, resection and primary anastomosis, and enterotomy with irrigation and primary closure. During the period 1991-2003, five newborns required surgical intervention for uncomplicated meconium ileus. None responded to conservative management. All were males, including one set of twins. All underwent laparotomy, enterotomy, appendectomy, irrigation and closure of enterotomy. None required a second surgical procedure. CF was confirmed in all, and in each case, both parents were found to be genetic carriers of a mutational form of CF. A single surgical intervention is preferable in these patients, in view of the high rate of pulmonary involvement in CF patients. Enterotomy, irrigation and primary closure are the treatment of choice for uncomplicated meconium ileus.

Humans↗

Bowel problems after enterocystoplasty.

OBJECTIVES: To document the changes in bowel habit in patients who have undergone enterocystoplasty. PATIENTS AND METHODS: Sixty-nine patients with neuropathic (NP) and 44 with non-neuropathic (NNP) bladder dysfunction (mean age 26 years, range 13-61, 93.6% socially continent), followed for at least 36 months after cystoplasty, were assessed using a questionnaire addressing faecal frequency, consistency, method of evacuation and incontinence episodes before and after surgery. RESULTS: Of the patients with NP bladder dysfunction, 26 (38%) had more and seven (10%) less frequent bowel action after surgery, with 36 (52%) unchanged; 38 (55%) of patients had unchanged consistency, 26 (38%) were looser and five (7%) more constipated; 41 (59%) opened their bowels as before, 16 (23%) needed more help and 12 (17%) less help to evacuate; 16 (23%) patients had more and 17 (25%) less episodes of incontinence; 21 (30%) patients felt their bowels had not become normal after their operation and only 24 (35%) that they had returned to normal within 3 months of their operation. The bowel segment used was ileum in 44 patients, ileocaecal in 11 and sigmoid cystoplasty in 14. Patients with intact ileum did not have the same degree of diarrhoea, with only three of the 14 patients with a sigmoid cystoplasty being adversely affected. Of the patients with NNP bladder dysfunction, 18 patients (41%) had a more and five (11%) a less frequent bowel action; 20 (46%) had more loose and five (11%) less loose bowel action; similar numbers (five and four) needed either an increase or a decrease in laxatives or enemata: surprisingly, 12 patients (27%) felt they had an increase in the episodes of incontinence; 17 (39%) patients felt their bowels returned to normal within 3 months of surgery and 30% felt their bowels had not become normal after surgery. Only one patient in this group had a sigmoid cystoplasty and she did not find that the operation interfered with her bowel function. CONCLUSIONS: Ileal resection results in malabsorption of bile acids, maldigestion of fat and an imbalance of water and electrolytes. Patients with neurogenic bladders are finely balanced between acceptable bowel function and choas, and surgery often tips this balance the wrong way. In 30% of the present patients, bowel problems persisted after surgery, with 38% having increased frequency. 38% having looser consistency and 23% more incontinence episodes following surgery. More surprisingly, a high percentage of NNP patients had bowel problems after cystoplasty.

Adolescent↗

Rectal necrosis after a phosphate enema.

We describe a patient who developed rectal ulceration after an apparently minor injury caused during the administration of a 130 ml 'disposable' phosphates enema. Treatment included parenteral antibiotics and a colostomy. Minor degrees of injury by rectal procedures are common. Rectal necrosis is a complication of injury during the administration of phosphates enemata which, although rare, deserves greater awareness. Painless rectal bleeding may be the only sign of injury and is an indication for thorough and repeated rectal examinations and early intervention.

Aged↗

Alterations of the colonic flora and their effect on the hydrogen breath test.

The hydrogen breath test was performed by ingestion of 20 g lactulose and analysis of end-expiratory air. Eighteen patients undergoing colonoscopy, 17 receiving antibiotics, 12 prepared for colon surgery, and 15 controls were examined. The test was repeated under control conditions in the treated patients. Eleven of 55 subjects failed to produce significant amounts of hydrogen under control conditions. This 20% proportion of non-hydrogen producers is much higher than that reported by other investigators. The hydrogen production was very markedly depressed after preparation for colonscopy and antibiotic therapy. The effect of neomycin and enemata as used in preparation for colon surgery was less marked. Hydrogen production by the colonic flora is thus subject to individual variations and may be affected by various therapeutic regimens. All these may cause false negative results when using the hydrogen breath test to evaluate carbohydrate absorption. The test should therefore not be performed for a considerable time after therapeutic manipulation of the colonic flora.

Adolescent↗

Rectally administered prednisolone--evidence for a predominantly local action.

Plasma prednisolone levels have been compared in healthy volunteers and in patients suffering from idiopathic proctocolitis after the administration of standard retention enemata containing either prednisolone-21-phosphate or prednisolone metasulphobenzoate sodium. The levels were significantly lower after the latter, irrespective of the presence or degree of activity of the disease. Prednisolone metasulphobenzoate appeared to be as effective as the 21-phosphate ester for the treatment of proctocolitis in the few patients where the two drugs were compared. It seems possible that the beneficial effect of the form of therapy is exerted predominantly locally, rather than by systemic action.

Colitis↗