A Case of Dyschezia Due to Cervical Spinal Cord Injury Successfully Treated by Antegrade Glycerin Enema via Percutaneous Endoscopic Cecostomy

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A 41-year-old man with injured cervical spinal cord between the 6th and 7th vertebra had suffered from intractable dyschezia as sequelae of injury for more than 20 years. It took more than two hours to complete defecation with retrograde glycerin enema four to five times following abdominal massage three times per week, severely affecting his quality of life. He uses an electric wheelchair controlled by his right hand. Although he has been free from gross fecal incontinence, anorectal sensation was thoroughly impaired. A percutaneous tube cecostomy was successfully created endoscopically under x-ray fluoroscopy without anesthesia. Through it, 120 ml of antegrade glycerin enema was applied, which successfully released him from persistent difficult defecation, and shortened his evacuation time to about 20 minutes. His medical fees including cecostomy creation, hospitalization and inserted tubes were all covered by social medical insurance. He could continue the antegrade glycerin enema at home after moving to a shower chair twice per week. The endoscopic percutaneous tube cecostomy procedure is a safe, and antegrade glycerin enema is an effective method for treating dyschezia derived from spinal cord injury.