Cecostomy

A cecostomy is a minor procedure to install a tube (cecostomy tube or C tube) through your abdomen into the first part of your large intestine (your cecum). You or a healthcare provider will use the tube to perform enemas that help move poop through your intestine and out the other end (your anus). They’re called antegrade enemas because they start from the beginning of your intestine and flow forward.

Antegrade enemas are more effective in clearing your bowels than traditional retrograde enemas. Retrograde enemas start from the bottom of your intestine and inject fluid up into it. These only reach so far. An antegrade enema flushes out your whole intestine. You (or a child) might need this if you have severe difficulties moving or controlling your bowels. A cecostomy can be a temporary or long-term solution.

Types of cecostomy tubes

• C tube: This is the temporary tube you get during your cecostomy. It’s a long, skinny catheter, similar to a feeding tube (PEG tube). The outer end of the tube coils against your abdomen.
• Chait Trapdoor™: The semi-permanent trapdoor cecostomy tube looks like a button on the outer side. On the inside, the tail coils within your cecum. This holds it in place without stitches.
• MiniACE^® Enema Button: The semi-permanent MiniACE® cecostomy tube also looks like a button on the outside. On the inside, an inflated balloon holds the end within your cecum.

Who can a cecostomy help?

Cecostomy is a frequent procedure in pediatric medicine. Children can develop severe constipation that leads to fecal incontinence. Children can also be born with conditions that affect their bowels, including:

• Anorectal malformations
• Hirschsprung disease
• Spina bifida

Cecostomy isn’t typically recommended for adults and isn’t currently part of the procedure for constipation management.

There are special cases when regular antegrade enemas can be indicated. By scheduling bowel movements, you can prevent accidents and poop from backing up.

How should I prepare?

Your healthcare provider might ask you to complete a bowel preparation before the procedure. This means you’ll follow a restricted diet for several days and then take laxatives to clear out your bowel.

If you’re preparing your child for a cecostomy, calmly and carefully explain to them everything that will happen. Children feel secure when they know what to expect and their parents project confidence.

What happens during a cecostomy?

During a cecostomy, your provider will do the following:

1. Create a small opening in your cecum (large intestine) through your abdomen. They might use a needle (percutaneous cecostomy) or make a small incision (surgical cecostomy). If you have a percutaneous cecostomy, you might only need local anesthesia or sedation. If you have a surgical cecostomy, you’ll have general anesthesia and sleep through the procedure.
2. Place the cecostomy tube. After creating the opening (ostomy), your provider will use medical imaging (like fluoroscopy or endoscopy) to thread a catheter through the opening into your cecum. A catheter is a long, thin, flexible tube (your cecostomy tube or C tube). They’ll fasten the tube to your cecum, then your cecum to your abdominal wall, close to the ostomy.

What happens after the procedure?

The procedure itself takes about an hour. After the cecostomy, you or your child may need to stay in the hospital for a few days. Your healthcare team will monitor you for potential complications and treat you with IV antibiotics to prevent infections. You can have pain medications if you need them. Your bowels won’t want to work right away after the procedure. So, you’ll be on a liquid diet until they do.

What are the risks and benefits of cecostomy?

Many people who’ve struggled with fecal incontinence or constipation find a cecostomy life-changing. Antegrade enemas take time (about an hour each day). But you can schedule them at your convenience and arrange your life around them. This puts you back in control of your bowel movements, instead of making you worry about when they’ll occur. For children, it can offer new independence.

Complications from the procedure itself are rare. They include infection and accidental injury to your bowel or a blood vessel. Most potential complications happen during or after the healing process.

They include:

• Irritation, swelling or scarring around the ostomy
• Tube malfunctions, like leaking or slipping out of place
• Infections that develop after using the cecostomy tube

Your healthcare team will explain how to care for the cecostomy. They’ll teach you how to clean the C tube daily to minimize these risks and complications. If they occur, they might need to remove or replace the tube.

How long does it take to recover?

It takes about two weeks for the cecostomy to heal. You’ll need to avoid swimming and bathing until then. After that, you’ll return to have your stitches removed. You may be able to start using the C tube after the first week. You can be active with the C tube, as long as you take care to secure it so it doesn’t catch on clothing. But you should avoid rigorous physical activity for the first four to six weeks.

When will the cecostomy be ready to use?

After a week or two, you should be able to start using the cecostomy to perform antegrade enemas. Your doctor will provide the formula to use and instructions on how to use the C tube.

The tube you get during the cecostomy is temporary. You’ll use it for six to eight weeks. After that, you’ll return to your healthcare provider for a simple, in-office procedure to replace it with a semi-permanent one.

Semi-permanent cecostomy tubes have a low-profile, button design. They lie flat against your abdomen. When you use the tube for an enema, you attach an additional connector tube to the outer end. This connector tube connects to the enema bag.

You can use this type of cecostomy tube for as long as you need. Healthcare providers recommend replacing the tubes every six to 12 months for good hygiene.

When should I call my healthcare provider?

Be sure to call your provider if you or your child has:

• Signs of infection, like a fever or discharge from the cecostomy
• Unusual pain, swelling or bleeding from the cecostomy
• Tube malfunctions, like if it moves or falls out

What is the prognosis after treatment with cecostomy and antegrade enemas?

Your long-term prognosis (outlook) mostly depends on your condition and its cause. Some conditions are lifelong, but others can improve.

Some people who use cecostomy tubes for a while are able to stop when their bowel health improves. In this case, your healthcare provider can close the ostomy. Others may use it forever. Still others might transition to a different type of ostomy.