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State of the Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation
Elizaveta Bokova1, Wendy Jo Svetanoff1, John M Rosen2,3
1Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA.
Insights
Most pediatric functional constipation (FC) cases can be managed non-surgically. Conservative treatments are effective, but further research is needed for surgical strategies in refractory cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Functional constipation (FC) impacts up to 32% of children, often requiring pediatric surgical intervention for constipation and fecal incontinence.
- This paper reviews current evaluation and management strategies for pediatric FC, as part of a series on bowel management.
Purpose of the Study:
- To provide recent updates on the evaluation and management of functional constipation in children.
- To inform pediatric surgeons and gastroenterologists on best practices for pediatric bowel management.
Main Methods:
- A comprehensive literature search was conducted using major databases (Medline/PubMed, Google Scholar, Cochrane, EMBASE).
- Focus was placed on studies published within the last 5-10 years to ensure relevance.
Main Results:
- Initial management involves excluding Hirschsprung disease via contrast study, examination under anesthesia, and anorectal manometry (AMAN).
- Medical options include laxatives, enemas, transanal irrigations, and antegrade flushes; surgical resection is considered for refractory cases.
- Specific procedures like subtotal colectomy or Deloyer's procedure may be guided by a balloon expulsion test.
Conclusions:
- The majority of pediatric FC patients referred for surgical evaluation achieve success with conservative management.
- Optimal surgical strategies for children unresponsive to medical treatment require further investigation.
Background:
Functional constipation (FC) affects up to 32% of the pediatric population, and some of these patients are referred to pediatric surgery units to manage their constipation and/or fecal incontinence. The aim of the current paper is to report the recent updates on the evaluation and management of children with FC as a part of a manuscript series on bowel management in patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and FC.
Methods:
A literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published within the last 5-10 years.
Results:
The first step of management of children with FC is to exclude Hirschsprung disease with a contrast study, examination under anesthesia, anorectal manometry (AMAN). If AMAN shows absent rectoanal inhibitory reflex, a rectal biopsy is performed. Internal sphincter achalasia or high resting pressures indicate botulinum toxin injection. Medical management options include laxatives, rectal enemas, transanal irrigations, and antegrade flushes. Those who fail conservative treatment require further assessment of colonic motility and can be candidates for colonic resection. The type of resection (subtotal colonic resection vs. Deloyer's procedure) can be guided with a balloon expulsion test.
Conclusion:
Most of the patients with FC referred for surgical evaluation can be managed conservatively. Further studies are required to determine an optimal strategy of surgical resection in children unresponsive to medical treatment.
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