Functional constipation refractory to medical management: The colon is the problem

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Colorectal Surgery

Background:

• Standardized management for refractory constipation in children is lacking.
• A protocol involving contrast enema, anorectal manometry, and Hirschsprung disease exclusion is proposed.
• Colonic motility assessment and Malone appendicostomy are key components for selected patients.

Purpose of the Study:

• To introduce and evaluate a protocolized approach for managing medically refractory constipation in children.
• To assess the efficacy of colonic manometry and Malone appendicostomy in identifying and treating colonic dysmotility.
• To reduce the need for colonic resection in pediatric patients with severe constipation.

Main Methods:

• A retrospective review of patients with refractory constipation from 2020-2021.
• Patients without Hirschsprung disease or sphincter issues underwent colonic manometry.
• Malone appendicostomy was performed for antegrade flushes in cases of confirmed colonic dysmotility.

Main Results:

• Out of 196 patients, 22 had colonic motility disorders.
• 19 of these 22 patients (86%) responded well to antegrade flushes, with 17 experiencing no soiling.
• Only 3 patients (14%) failed antegrade flushes and required colon resection.

Conclusions:

• A protocolized approach standardizes the evaluation and management of refractory constipation in children.
• Antegrade flushes via Malone appendicostomy are effective in managing colonic dysmotility.
• This protocol aids in avoiding colonic resection in the majority of cases.