Severe Postoperative Chronic Constipation Related to Anorectal Malformation Managed with Osteopathic Manipulative...

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Osteopathic Medicine

Background:

• Constipation is a common complication in infants post-anorectal malformation (ARM) surgery, often leading to discomfort and further issues like megacolon.
• Standard prokinetic protocols, including laxatives and dietary changes, are frequently used but may not resolve severe cases.
• Osteopathic manipulative treatment (OMT) is established for adult functional constipation but lacks pediatric application, especially post-ARM surgery.

Observation:

• A case study involving an infant with severe constipation and pseudoincontinence, refractory to conventional prokinetic protocols two years after anorectoplasty for low ARM.
• The infant presented with pelvic floor tension and parasympathetic plexus immaturity, contributing to a dysfunctional defecation reflex.
• Osteopathic manipulative treatment (OMT) was introduced as an adjunct therapy.

Findings:

• Following the adjunction of OMT, the infant experienced gradual remission of constipation.
• The child achieved autonomous daily bowel movements within four months of initiating OMT.
• This suggests a potential benefit of OMT in addressing functional defecation disorders post-ARM surgery.

Implications:

• Investigating the efficacy of incorporating OMT into post-surgical prokinetic protocols for pediatric ARM patients with good prognoses is warranted.
• OMT may offer a novel therapeutic avenue for managing refractory constipation in this specific pediatric population.
• This case highlights the potential role of manual therapies in addressing complex functional gastrointestinal disorders in children.