Effect of high volume enema in children with abdominal pain: Pediatric emergency department experience

BACKGROUND: Abdominal pain is one of the most common reasons for admission to the pediatric emergency clinic. The appropriate evaluation of clinical and laboratory clues to make the correct diagnosis is of great importance in terms of directing the treatment medically or surgically and preventing unnecessary investigations. The aim of our study was to evaluate the contribution of high-volume enema application among pediatric patients with abdominal pain in terms of clinical and radiological findings.
METHODS: Among the pediatric patients who applied to the pediatric emergency clinic of our hospital between January 2020 and July 2021 with abdominal pain, those who had intense gas stool image on abdominal X-ray and abdominal distension on physical examination and who underwent high-volume enema treatment were included in the study. The physical examination and radiological findings of these patients were evaluated.
RESULTS: During the study period, 7819 patients were admitted to the pediatric emergency outpatient clinic with abdominal pain. Classic enema was performed in 3817 of these patients who had a dense gaseous stool image and abdominal distention on abdominal X-ray graphy. Defecation occurred in 3498 (91.6%) of 3817 patients who underwent classical enema, and the complaints regressed after enema. High-volume enema was applied to 319 (8.4%) patients who did not find relief with classical enema. Complaints of 278 (87.1%) patients regressed after the high-volume enema. Control ultrasonography (US) was performed in the remaining 41 (12.9%) patients, 14 (34.1%) patients were diagnosed with appendicitis. US results of 27 (65.9%) patients who had repeated US were evaluated as normal.
CONCLUSION: High volume enema treatment is an effective and safe method in children with abdominal pain who are unresponsive to classical enema application in the pediatric emergency department.

Karýn aðrýsý olan çocuklarda yüksek volüm lavmanýn etkisi: Çocuk acil klinik deneyimi

AMAÇ: Karýn aðrýsý, çocuk acil polikliniðine en sýk baþvuru nedenlerinden biridir. Doðru tanýya gidebilmek için klinik ve laboratuvar ipuçlarýnýn uygun þekilde deðerlendirilmesi, tedavinin týbbi ya da cerrahi olarak yönlendirilmesi ve gereksiz incelemelerin önüne geçilmesi açýsýndan büyük önem taþýr. Çalýþmamýzýn amacý karýn aðrýlý çocuk hastalarda yüksek volüm lavman uygulamasýnýn klinik ve radyolojik bulgulara katkýsýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Hastanemiz Çocuk Acil Kliniðine Ocak 2020–Temmuz 2021 tarihleri arasýnda karýn aðrýsý þikayeti ile baþvuran çocuk hastalardan; fizik muayenede karýn þiþliði ve direkt karýn grafisinde yoðun gaz, gaita retansiyonu olan ve yüksek volüm lavman tedavisi uygulanan hastalar çalýþmaya dahil edildi. Bu hastalarýn fizik muayene ve radyolojik bulgularý deðerlendiridi.
BULGULAR: Çalýþma tarihleri arasýnda 7819 hasta çocuk acil polikliniðine karýn aðrýsý ile baþvurdu. Direkt karýn grafisinde yoðun gaz, gaita imajý ve karýn distansiyonu olan hastalarýn 3817’sine klasik lavman yapýldý. Klasik lavman yapýlan 3817 hastanýn 3498’inde (%91.6) gaita çýkýþý ve lavman sonrasý þikayetlerinde gerileme oldu. Klasik lavmanla rahatlama olmayan 319 (%8.4) hastaya yüksek volüm lavman uygulandý. Yüksek volüm lavman sonrasý 278 (%87.1) hastanýn þikayet ve bulgularý geriledi. Kalan 41(%12.9) hastaya kontrol ultrasonografi yapýldý, 14 (%34.1) hastaya apandisit tanýsý konuldu. Ultrasonografi tekrarý yapýlan 27 (%65.9) hastanýn ise ultrasonografi sonucu normal olarak deðerlendirildi.
TARTIÞMA: Çocuk acil kliniðinde, klasik lavman uygulamasýna yanýt vermeyen karýn aðrýsý þikayeti olan çocuklarda yüksek volüm lavman tedavisi etkili ve güvenli bir yöntemdir.