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Published on: December 8, 2014

Management of pediatric patients with refractory constipation who fail cecostomy

Silvana F Bonilla1, Alejandro Flores, Carl-Christian A Jackson

  • 1Division of Pediatric Gastroenterology, Floating Hospital for Children at Tufts Medical Center.

Journal of Pediatric Surgery
|October 1, 2013
PubMed

Insights

16% of children with refractory constipation failed antegrade continence enema (ACE) therapy. Surgical intervention improved outcomes for most, but some experienced persistent issues, highlighting the complexity of pediatric bowel management.

Area of Science:

  • Pediatric Gastroenterology
  • Surgical Management of Bowel Dysfunction
  • Colorectal Surgery

Background:

  • Antegrade continence enema (ACE) is a treatment for pediatric refractory constipation.
  • Long-term outcomes for patients with ACE failure are not well-documented.

Purpose of the Study:

  • To determine the failure rate of ACE in pediatric refractory constipation.
  • To describe the management and long-term outcomes of patients with ACE failure.

Main Methods:

  • Retrospective analysis of pediatric patients with at least 3-year follow-up after ACE.
  • Detailed review of subsequent treatments and outcomes for patients with poor functional results.

Main Results:

  • 16% of 76 patients failed ACE, requiring further intervention.
  • Colonic motility studies revealed neuropathy or motility disorders in most failures.
  • Surgery led to marked improvement in 75% of patients, with 25% having persistent issues.

Conclusions:

  • Colonic resection improved or resolved symptoms in most patients who failed ACE.
  • Patients failing ACE represent a complex, heterogeneous group with potential for ongoing challenges.
Abstract

Keywords:
Abdominal painAntegrade continence enemas (ACE)CecostomyColonic resectionConstipationTotal colectomy

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