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Treatment of severe childhood constipation with restorative proctocolectomy
1Department of Paediatric Surgery, The Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK.
Insights
Restorative proctocolectomy can resolve severe constipation in children unresponsive to other treatments. This procedure allows bowel movements through the anus, avoiding permanent stomas and improving quality of life.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- Severe constipation in children poses significant challenges.
- Medical and enema therapies are often insufficient for refractory cases.
Observation:
- A study observed five children with severe constipation.
- These children required stomas due to failed conservative treatments.
- All participants underwent restorative proctocolectomy.
Findings:
- All children achieved anal stooling post-surgery.
- Mean stool frequency was 6/day with no daytime incontinence.
- Low complication rates and no permanent morbidity were reported.
- Mean gastrointestinal quality of life score (GIQL) was 89 at 3 years.
Implications:
- Restorative proctocolectomy is a viable option for select pediatric patients with severe constipation.
- The procedure can successfully resolve symptoms and eliminate the need for a permanent stoma.
- Improved quality of life is achievable following this surgical intervention.
Objective:
To describe the clinical features of children with severe constipation and their outcome after restorative proctocolectomy.
Design:
Observational study and health status questionnaire using gastrointestinal quality of life score (GIQL).
Setting:
English regional paediatric surgery service.
Patients:
Five children were identified, with severe constipation, whose symptoms had not improved with either prolonged medical therapy or colonic lavage using an antegrade colonic enema procedure. All had required a stoma to resolve their constipation. Intervention All underwent restorative proctocolectomy.
Results:
All children are stooling through their anus. The mean stool frequency is 6/day. None have daytime incontinence, and none require any further therapy for constipation. Complication rates have been low with no permanent morbidity. The mean GIQL 3 years following restorative proctocolectomy was 89 (SD 29).
Conclusions:
In highly selected cases, restorative proctocolectomy may allow resolution of the symptoms of severe constipation and avoid leaving a child with a permanent stoma.
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