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Management of pediatric patients with refractory constipation who fail cecostomy.

Abstract：

BACKGROUND:Antegrade continence enema (ACE) is a recognized therapeutic option in the management of pediatric refractory constipation. Data on the long-term outcome of patients who fail to improve after an ACE-procedure are lacking. PURPOSE:To describe the rate of ACE bowel management failure in pediatric refractory constipation, and the management and long term outcome of these patients. METHODS:Retrospective analysis of a cohort of patients that underwent ACE-procedure and had at least 3-year-follow-up. Detailed analysis of subsequent treatment and outcome of those patients with a poor functional outcome was performed. RESULTS:76 patients were included. 12 (16%) failed successful bowel management after ACE requiring additional intervention. Mean follow-up was 66.3 (range 35-95 months) after ACE-procedure. Colonic motility studies demonstrated colonic neuropathy in 7 patients (58%); abnormal motility in 4 patients (33%), and abnormal left-sided colonic motility in 1 patient (9%). All 12 patients were ultimately treated surgically. Nine patients (75%) had marked clinical improvement, whereas 3 patients (25%) continued to have poor function issues at long term follow-up. CONCLUSIONS:Colonic resection, either segmental or total, led to improvement or resolution of symptoms in the majority of patients who failed cecostomy. However, this is a complex and heterogeneous group and some patients will have continued issues.

journal_name

J Pediatr Surg

journal_title

Journal of pediatric surgery

authors

Bonilla SF,Flores A,Jackson CC,Chwals WJ,Orkin BA

doi

10.1016/j.jpedsurg.2012.12.034

subject

Has Abstract

pub_date

2013-09-01 00:00:00

pages

1931-5

issue

9

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(12)01062-7

journal_volume

48

pub_type

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