Original ArticleManagement of pediatric patients with refractory constipation who fail cecostomy
Section snippets
Materials and methods
We conducted a retrospective analysis of a cohort of patients with chronic refractory constipation that underwent cecostomy for administration of ACE at The Floating Hospital for Children at Tufts Medical Center between April 2003 and January 2011. The technique has been described previously [3]. Detailed analysis of the subgroup of patients who failed to improve after cecostomy was performed including demographic variables, medical history, symptoms, subsequent treatment and clinical outcome.
Results
Seventy six patients underwent cecostomy during the study period. Twelve patients (16%) failed successful bowel management after cecostomy and were included in the study (Table 1). This subgroup of patients did not differ from the patients that succeeded in regards to demographic variables, clinical presentation and manometric findings in our series. The mean age for this subgroup of patients was 14.7±1.2 SEM (range 11–23 years). The mean follow-up time was 66.3 months (range 35–95 months) after
Discussion
Since its first description in 1990 [13], the ACE procedure has become a recognized therapeutic option in the management of children with intractable constipation who fail medical regimen and who have Hirschsprung's disease ruled out by rectal biopsy. In this paper, we describe the long term outcome of a cohort of pediatric patients with chronic constipation who failed to achieve successful bowel management after cecostomy placement. Only a small percentage of pediatric patients fail to respond
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2021, Journal of Pediatric SurgeryCitation Excerpt :We selected the papers specifically describing the antegrade or retrograde use of enemas for the treatment of fecal incontinence, severe intractable constipation, colonic motility disorders in children and in adults. Forty-three publications were selected for review. (1–43) The type of enemas have varied in these patients, as well as the ingredients that the patients were receiving, including saline solution/glycerin (six cases), only saline solution (five), saline solution/glycerin/soap (four), plain water (three), and one case each of molasses/milk, saline solution/glycerin/soap/phosphate, saline solution/phosphate, and only phosphate (Table 1).
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