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Surgically correctable fecal incontinence
Insights
Many children with fecal incontinence have correctable surgical issues. Prompt diagnosis and appropriate anorectal surgery can significantly improve continence in pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Anorectal Malformations
Background:
- Fecal incontinence in children often stems from surgically correctable anorectal problems.
- Failure to recognize or improperly address these issues leads to persistent incontinence.
Observation:
- The study reviewed ten children with prior anorectal surgeries and two with anterior anus.
- Seven patients had undergone poorly positioned pull-through procedures for imperforate anus.
- Two children had overflow incontinence after Duhamel operations for Hirschsprung's disease.
Findings:
- Anal repositioning successfully treated four of seven imperforate anus cases.
- Gracilis sling achieved continence in two of three remaining imperforate anus cases.
- Division of an anorectal septum corrected overflow in two Duhamel procedure cases, and an anoplasty resolved it in a third.
- Posterior anoplasty successfully created continence in two children with anterior ectopic anus.
Implications:
- Anorectal malformations and anatomical deviations are key causes of pediatric fecal incontinence.
- Physical examination and defecography are crucial diagnostic tools.
- Corrective surgical interventions can restore fecal continence in a majority of affected children.
Abstract:
A significant percentage of children who are fecally incontinent are so from improper operation or failure to recognize a surgically correctable problem. Over the past five years, we have managed ten children who had operations for anorectal problems and two with anterior anus. Seven were seen after poorly positioned pull-through procedures for imperforate anus and had anal repositioning, four successfully. Gracilis sling was successful in two of the other three. In two children overflow after a Duhamel operation for Hirschsprung's disease was corrected by division of a persistent anorectal septum. The third child with a disrupted Duhamel procedure was cured by anolevatorplasty. In two children an anterior ectopic anus was made continent by posterior anoplasty. Primary and secondary deviations from proper anatomy of the anorectal region will result in incontinence, which may be recognized by physical examination and defecograms. Proper operation usually produces acceptable continence.