A strategy of drainage of acute sepsis, maintenance of nutritional support prior to surgery, and selective use of PS allows for primary closure in 80% of complicated ECF. Resection should be performed when feasible.

Study Design: Review. Objectives: To outline the present knowledge of bowel dysfunction following spinal injury, and look at future directions of management and research. Setting: Spinal Unit and Colorectal Unit, Christchurch, New Zealand. Methodology: Review. Results: The underlying physiology of colorectal motility and defecation is reviewed, and consequences of spinal cord injury on defecation are reported. A discussion of present management techniques is undertaken and new directions in management and research are suggested. Conclusion: There is need for more intervention in regard to bowel function that could improve quality of life, but there is also a need for more research in this area.

Study design: A controlled, descriptive and comparative, questionnaire based study. Objectives: To describe the bowel function of spinal cord injured (SCI) patients and compare this with a general community control group. Setting: Christchurch, New Zealand. Methodology: A postal questionnaire was sent out to past SCI patients of the Burwood Spinal Injuries Unit, Christchurch, New Zealand, and age/gender matched with controls randomly selected from the electoral roll. Permission was obtained from SCI participants to retrieve data relating to their injury from hospital case notes. The questionnaire detailed general bowel function, in¯uence of bowel problems on everyday life, incidence of incontinence and methods of defecation. A Faecal Incontinence Score was generated according to an established incontinence grading scheme. Results: Questionnaires were sent out to 1200 SCI patients and 1200 control subjects. Of these, 467 completed questionnaires were returned from SCI patients and age/gender matched from the 668 returned control questionnaires. Mean Faecal Incontinence Score was higher for SCI patients than controls (P50.0001), and for complete compared with incomplete injury (P=0.0023). Age or time from injury did not aect Faecal Incontinence Score. Incontinence aected quality of life for 62% of SCI patients, compared with 8% of controls. Faecal urgency and time spent at the toilet were also signi®cantly higher for the SCI group (39% of SCI patients use laxatives, compared with 4% of controls (P50.0001)). Haemorrhoidectomy was more common (P50.001) in the SCI population (9% vs 1.5%), particularly among those requiring manual evacuations. Conclusion: SCI has a signi®cant eect on bowel function in terms of faecal incontinence, urgency, and toileting methods. This results in a marked impact on quality of life. While bowel function may deteriorate with time, most patients with poor function can be identi®ed early implying a role for early intervention in those with potential bowel problems, such as colostomy or ACE procedure.

Purpose: Spinal cord injured (SCI) patients have delayed colonic motility and anorectal dysfunction resulting in functional obstruction and constipation. This may be caused by changes in descending modulation from the central or sympathetic nervous systems. Anorectal dyssynergy may demonstrate similarities to that seen in the bladder following SCI. Methodology: Anorectal manometry was performed on 37 SCI volunteers. Patterns of rectal and sphincter function were identi®ed. These patterns were then compared with questionnaire answers on bowel function and cystometrograms to identify a relationship between detrusor dyssynergy and anal sphincter tone. Results: Rectal compliance and basal resting sphincter pressures were lower than normal values. Ramp rectal in¯ation demonstrated patterns of sphincter activity similar to that recorded in the patients' cystometrograms. There is no de®nite relationship of bowel function to the ®ndings on manometry in SCI patients. Conclusions: SCI patients have abnormal anorectal function. Anorectal manometry results were able to be classi®ed into four patterns on the basis of rectal pressure and sphincter tone in response to rectal distention. The patterns of anorectal manometry seen were similar to those in cystometrograms, however there is no de®nite relationship to bowel dysfunction. Spinal Cord (2000) 38, 573 ± 580