From the Guidelines
Fleet enemas are not recommended for patients with Crohn's disease and a recent small bowel obstruction due to the risk of worsening inflammation, causing perforation, or exacerbating the obstruction. The use of Fleet enemas in this situation could lead to serious complications, and alternative approaches should be considered. For patients with Crohn's disease who have recently experienced a small bowel obstruction, bowel management should be directed by a gastroenterologist or surgeon familiar with the patient's specific condition 1.
Key Considerations
- Patients with Crohn's disease and recent bowel obstructions require careful management as their intestinal walls may be weakened by inflammation and scarring, making them more susceptible to injury from mechanical stimulation 1.
- Any intervention that increases pressure within the bowel could potentially lead to complications, and therefore, gentle approaches are preferred.
- Alternative approaches for constipation might include gentle oral osmotic laxatives like polyethylene glycol (Miralax) at 17g daily mixed in water, once the obstruction has fully resolved and only if recommended by the treating physician.
- The ECCO-ESGAR guideline also advises against the use of purgatives, especially Fleet enemas and oral sodium phosphate preparations, in patients with inflammatory bowel disease 1.
Management Approach
- Focus should be on treating the underlying Crohn's disease with appropriate medications, maintaining proper hydration, following a low-residue diet during flares, and working closely with healthcare providers to prevent future obstructions 1.
- Endoscopic balloon dilation has proven successful in the management of primary intestinal strictures or anastomotic strictures in Crohn's disease, with a technical success rate of 89 to 92% 1.
- Surgery is warranted for small bowel Crohn's disease stenosis that causes an intestinal obstruction with potential impending perforation, with long or multiple strictures, when the stricture is not endoscopically accessible, and when medical and/or endoscopic treatment fails to adequately improve the patient’s symptoms or when there is concern about concomitant malignancy 1.
From the Research
Safety of Fleet Enema for Crohn's Disease Patients with Recent Small Bowel Obstruction
- The safety of using a Fleet enema (sodium phosphate enema) for a patient with Crohn's disease and a recent small bowel obstruction is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, the studies discuss the management and treatment of small bowel obstructions in patients with Crohn's disease, which may be relevant to considering the safety of using a Fleet enema in this context.
- For example, a study on the clinical presentation, diagnosis, and treatment of small bowel obstruction notes that medical resuscitation, including intravenous hydration and correcting electrolyte abnormalities, is a key part of treatment 3.
- Another study discusses the use of computed tomography imaging and clinical data to predict the need for surgery in patients with Crohn's disease and acute small bowel obstructions 5.
- The use of a Fleet enema may be contraindicated in patients with certain conditions, such as bowel obstructions, as it can cause further irritation and potentially worsen the condition 3, 4.
- Therefore, it is essential to exercise caution and consider the individual patient's condition and medical history before using a Fleet enema in a patient with Crohn's disease and a recent small bowel obstruction.
Key Considerations
- The patient's recent small bowel obstruction and Crohn's disease diagnosis should be taken into account when considering the use of a Fleet enema 2, 3, 4, 5.
- The potential risks and benefits of using a Fleet enema in this context should be carefully weighed, and alternative treatments or management strategies may be necessary 3, 5.
- Consultation with a healthcare professional is essential to determine the safest and most effective course of treatment for the patient.
Relevant Studies
- A study on Crohn's disease obstructions notes that obstruction from stricturing Crohn's disease remains one of the most common reasons for intervention 2.
- A study on small-bowel obstruction associated with Crohn's enterolith discusses the formation of small-bowel enteroliths as a lesser-known clinical manifestation of Crohn's disease 4.
- A study on a clinical and radiographic model to predict surgery for acute small bowel obstruction in Crohn's disease discusses the use of computed tomography imaging and clinical data to predict the need for surgery 5.