Background: Fecal impaction (FI) can present with abdominal pain that mimics or coincides acute appendicitis. Low rectal
enema (LRE) can suddenly relieve abdominal pain and distinguish this condition from appendicitis. However, there is a
concern regarding the risk of delayed operation or appendiceal perforation after LRE in children who actually have appendicitis.
Objective: This study is aimed to determine the benefit and risk of LRE in children with uncertain causes of abdominal pain.
Material and Method: A retrospective chart-review cross-sectional study was conducted in children (2 to 15 years of age)
who were admitted to our division due to acute abdominal pain between January 1, 2001 and October 31, 2008. Patients who
had apparent peritonitis or previous abdominal surgery were excluded. Data collection includes demographic data, evidence
of FI, managements including LRE and/or appendectomy, perforation of appendix and length of stay.
Results: There were 403 patients included in the present study. The most common diagnoses were FI (43%) followed by
appendicitis (37.3%). FI was evident in 322 (79.9%) patients and LRE resulted in 204 (63.3%) resolution of symptoms.
Appendectomy was performed in 118 (36.6%) children in whom the pain was persistent after LRE. The overall ruptured and
negative appendectomy rates were 23.6% and 8.8%, respectively. Among 118 patients who had prior LRE, ruptured
appendicitis were found in 29 (24.6%) and negative appendectomy in 9 (7.6%) which were comparable to those who did not receive LRE. Interestingly, among 84 patients who were referred with the diagnosis of appendicitis, 51 (70.8%) were improved after LRE, avoiding unnecessary appendectomy. Neither immediate complication nor increased risk of perforated appendicitis from LRE were observed.
Conclusion: Low rectal enema is a safe procedure to distinguish fecal impaction from the other surgical condition in
children, especially for those who had palpable fecal mass by abdominal examination. This approach could avoid unnecessary
operation without increasing the risk of complication.

Keywords: Fecal impaction, Acute abdominal pain, Children, Low rectal enema