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[Severe chronic constipation: limitations of medical therapy and indications for surgical intervention. II]
P Campobasso1, C Pesce, A Mercurella
1Divisione di Chirurgia Pediatrica, Ospedale Regionale di Vicenza, Italia.
Insights
Severe chronic constipation in children often stems from functional issues, but a small percentage require surgery for organic causes like neurogenic or myogenic colonic abnormalities. Diagnosis involves extensive investigation, with surgery followed by long-term medical management.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Developmental Biology
Context:
- Severe chronic constipation is a prevalent pediatric issue.
- Most cases are functional, but 5% indicate underlying organic disease.
- Organic causes range from anatomical defects to neurogenic/myogenic colonic abnormalities.
Purpose:
- To differentiate functional from organic causes of severe chronic constipation in children.
- To outline diagnostic approaches for various organic etiologies.
- To highlight surgical and medical management strategies for specific organic conditions.
Summary:
- Anatomical problems (e.g., anal stenosis) require physical examination.
- Neurogenic/myogenic colonic abnormalities necessitate extensive investigations (histological, histochemical).
- Conditions like ultrashort Hirschsprung's disease, neuronal intestinal dysplasia type B, and hypoganglionosis involve enteric nervous system development issues and often require surgery followed by prolonged medical treatment.
Impact:
- Accurate diagnosis guides appropriate treatment, distinguishing between medical and surgical interventions.
- Understanding developmental origins of enteric nervous system disorders is crucial.
- Effective post-surgical management can prevent recurrence of functional constipation.
Abstract:
Severe chronic constipation is a common problem in children. Most patients have functional constipation, only few (approximately 5%) have an underlying organic disease who requires surgical treatment. Anatomic problems with a painful defecation (anal rhagades, fistulas, hemorrhoids) or with difficult defecation (anal stenosis, tumor) require only a careful physical examination. Other organic problems due to neurogenic and myogenic colonic abnormalities require extensive investigations, including histological and histochemical study, for diagnosis. Ultrashort Hirschprung's disease, neuronal intestinal dysplasia type B and hypoganglionosis represent different levels of a developmental problem of the enteric nervous system. Surgical treatment is recommended in these cases. After surgery is recommended a long period of medical treatment to avoid a functional constipation.