Management of chronic intractable constipation in children

Area of Science:

• Pediatric Gastroenterology
• Colorectal Surgery
• Functional Bowel Disorders

Background:

• Chronic intractable constipation (CIC) presents significant management challenges in pediatric populations.
• Current treatment modalities include medications, enemas, and surgical interventions for select cases.

Purpose of the Study:

• To evaluate the outcomes of surgical interventions for pediatric patients diagnosed with Chronic Intractable Constipation (CIC).
• To assess the utility of diagnostic investigations in understanding the pathophysiology of defecation disorders in children with CIC.

Main Methods:

• Retrospective review of medical records for pediatric patients with CIC (2005-2012).
• Collected demographic data, diagnostic procedures (anorectal manometry, colonic manometry, defecography), and medical/surgical outcomes.
• Clinical outcomes were assessed using the Rome III criteria.

Main Results:

• 14 pediatric patients with CIC were analyzed; 11 underwent cecostomy placement.
• 10 patients had a total abdominal colectomy with ileorectal anastomosis (TAC-IRA), with 7 reporting successful clinical outcomes.
• Colonic manometry revealed neuropathy in 11 of 12 patients; defecography showed various motility and/or pelvic floor dysfunctions in 8 patients.

Conclusions:

• Diagnostic tools like anorectal manometry, colonic manometry, and defecography aid in elucidating defecation disorder pathophysiology in children.
• Total abdominal colectomy with ileorectal anastomosis (TAC-IRA) appears to be a safe and effective intervention for a subset of pediatric CIC patients refractory to other treatments.
• No statistical correlation was found between individual diagnostic investigations and surgical intervention success.