(Kiosk 1) Peristeen Transanal Irrigation Treatment for Hepatic Encephalopathy and Neurogenic Bowel in the Acute Inpatient Rehabilitation Setting: A Case Report

Case Diagnosis: Treatment with Peristeen Transanal Irrigation System for Hepatic Encephalopathy and Neurogenic Bowel

Case Description or Program Description: On admission, the patient was somnolent with an ammonia level of 140 and a rectal tube for bowel incontinence. The patient received oral lactulose of 30 milliliters three times a day with resolution of symptoms and new perianal ulceration. The rectal tube was removed, and the patient was trialed on a daily lactulose enema of 900 millimeters resulting in adequate participation in therapy without liver decompensation. This bowel regimen was successful for several days, but the medical preparation and cost were too significant for the patient’s family. General surgery was consulted for colostomy placement and could not proceed due to the high estimated mortality rate of 30% based on her calculated Child-Pugh score of class B. The patient trialed a medical device called the peristeen transanal irrigation system resulting in successful bowel management and ease of care at discharge.

Setting: acute inpatient rehabilitation hospital

Assessment/Results: In this case, a large lactulose enema successfully prevented hepatic encephalopathy and allowed adequate participation in therapy, but the medical preparation placed a significant burden on the caregiver. The patient maintained the same outcomes with the peristeen device without the considerable burden and preventing high-risk surgery for colostomy.

Discussion (relevance): The peristeen transanal irrigation system is a medical device approved by the Food and Drug Administration in 2022 for adults with neurogenic bowel dysfunction who suffer from fecal incontinence and/ or time-consuming bowel management procedures. This single-use catheter empties the bowel by introducing water using a rectal catheter.

Conclusions: Bowel management in patients with complete spinal cord injury and liver cirrhosis is poorly documented in the research literature and can be challenging to manage. This case highlights the potential benefits of using a peristeen transanal irrigation system to optimize patient outcomes in this population.