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Surgical evaluation and management of refractory constipation in older children

B B Simpson1, D P Ryan, J J Schnitzer

  • 1Department of Pediatric Surgery, Massachusetts General Hospital, Boston 02114, USA.

Journal of Pediatric Surgery
|August 1, 1996
PubMed

Insights

Deep transanal rectal biopsy aids in diagnosing neuroenteric disorders in children with chronic constipation. This procedure identifies patients who may benefit from surgical intervention when medical management fails.

Area of Science:

  • Pediatric Gastroenterology
  • Surgical Pathology

Background:

  • Chronic constipation is a prevalent pediatric issue, often lacking a clear etiology despite thorough investigation.
  • Many children with refractory constipation undergo extensive evaluations without identifying a specific cause.

Purpose of the Study:

  • To assess the diagnostic utility of deep transanal rectal biopsy in evaluating pediatric patients with refractory constipation.
  • To determine if this biopsy aids in subsequent surgical management decisions.

Main Methods:

  • A 5-year retrospective review of patients referred for deep transanal rectal biopsy was conducted.
  • Diagnostic yield and impact on surgical treatment were analyzed for 70 patients.

Main Results:

  • The biopsy established a diagnosis in 30 out of 70 patients (43%).
  • Of those diagnosed, 17 patients (57%) proceeded to surgical treatment for their constipation.

Conclusions:

  • Deep transanal rectal biopsy is valuable for identifying previously unrecognized neuroenteric disorders in children with refractory constipation.
  • The procedure facilitates surgical management for a significant subset of patients unresponsive to medical therapies.

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