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Idiopathic megarectum in children
P P Godbole1, A Pinfield, M D Stringer
1Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, UK.
Summary
Idiopathic megarectum in children, often resistant to laxatives, presents with chronic soiling. Manual evacuation with stimulant suppositories offers effective management for many, while surgery benefits selected cases.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
Background:
- Idiopathic megarectum in children is poorly understood and managed.
- Chronic soiling is the primary symptom, often unresponsive to conventional laxative therapy.
Purpose of the Study:
- To investigate the management and outcomes of idiopathic megarectum in pediatric patients.
- To evaluate the efficacy of different treatment modalities.
Main Methods:
- Prospective identification of children with idiopathic megarectum (excluding Hirschsprung's disease and anorectal malformations).
- Assessment of megarectum severity via palpation and radiography.
- Evaluation of treatments including manual evacuation, stimulant suppositories, oral laxatives, and surgical intervention (Duhamel procedure).
Main Results:
- 29 children (22 boys, 7 girls) with a median age of 8.0 years were studied.
- 52% of patients achieved good results with manual evacuation and daily stimulant suppositories.
- Surgical management yielded excellent functional results in three boys with massive megarectums.
Conclusions:
- Idiopathic megarectum is more prevalent in boys and frequently resistant to oral laxatives alone.
- Stimulant suppositories, following preparation, can be effective.
- Surgery is a valuable option for selected cases of massive idiopathic megarectum.
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