Colorectal Quiz Episode 15: Bowel Management in Spinal Patients - Need for a UrologistPart 1

Senna-induced perineal rash is thought to be a chemical burn rather than a true allergy, presenting with blistering.

Senna rash is treated with silver sulfadiazine and resolves with time; some patients tolerate senna upon reintroduction.

Timing senna doses in the early morning so that bowel movements occur during the day (when diapers are changed promptly) reduces the risk of senna rash.

MiraLax softens stool but does not provide a 'push' to expel it, which can leave the colon full of soft stool.

Senna and bisacodyl are the two medications that provide a 'kick' or push for stool expulsion; everything else is a stool softener.

MiraLax is problematic for patients with anorectal malformations who need fullness to detect stool, because it makes soft stool that 'mushes out' without discrete sensation.

Bisacodyl can be administered as an enema or suppository in infants.

Glycerin is generally better tolerated than castile soap for enemas in children; castile soap commonly causes cramping and discomfort.

A Malone appendicostomy provides tube-free access for antegrade enemas via daily catheterization of the channel.

Children with spinal differences may need bladder access later in life, and the appendix is the preferred conduit for a Mitrofanoff urinary channel.

Coordination with urology from the beginning of bowel management planning is essential in spinal patients to preserve the appendix for potential urologic reconstruction.

A cecostomy tube (placed laparoscopically or by interventional radiology) provides direct access to the cecum for antegrade enemas and preserves the appendix for future reconstruction.

A non-plicating, non-trimmed Malone appendicostomy (tip of appendix sewn to right lower quadrant with a balloon tube, without plication or trimming) preserves the appendix for potential future urologic use or splitting.

An appendix of 2 cm is too short for either colorectal or urologic use; 5 cm goes to urology; 7 cm may be splittable (2 cm for colorectal, 5 cm for urology); longer appendices are certainly splittable.

Urologists prefer an appendix of at least 5 cm length for a Mitrofanoff; shorter appendices are not suitable for urologic use.

For urologic reconstruction, the appendix is preferred over a Monti channel made from small bowel for long-term outcomes.

A neo-Malone can be created from a flap of colon if the appendix is used for urologic purposes.

Taking down a cecostomy tube is relatively easy and leaves the appendix free for subsequent use.