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CC BY 4.0 · European J Pediatr Surg Rep. 2024; 12(01): e23-e25
DOI: 10.1055/a-2212-0411
Case Report

Colonic Resection in an 8-Year-Old Girl with Intractable Functional Constipation and Diffuse Colonic Dysmotility and Failed Antegrade Flushes

Gabriella Danziger
1   Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
,
Thomas O. Xu 
1   Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
,
Teresa Lynn Russell 
1   Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
,
Laura Tiusaba 
1   Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
,
Jennie Yun
1   Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
,
Marc A. Levitt
1   Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
,
Andrea Badillo
1   Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
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Abstract

Optimal surgical management of patients with intractable constipation and diffuse colonic motility is not well defined. We present a patient with such a history, who ultimately achieved successful surgical management of constipation through a stepwise approach. An 8-year-old female presents with longstanding constipation and diffuse colonic dysmotility demonstrated with colonic manometry. She initially underwent sigmoid resection and cecostomy which failed and required diverting ileostomy. We initially proceeded with an extended resection, colonic derotation (Deloyers procedure), and neo-appendicostomy (neo-Malone) which resulted in successful spontaneous stooling for 1 year. Her constipation recurred and she subsequently underwent completion colectomy with ileorectal anastomosis given that she previously demonstrated ability to stool independently. Six months from surgery the patient continues to stool daily with assistance of fiber and loperamide. This case highlights a stepwise surgical approach to managing constipation due to diffuse colonic dysmotility and demonstrates that diffuse dysmotility may benefit from an upfront subtotal resection; however, it is crucial to assess a patient's ability to empty their rectum prior.

Keywords

functional constipation - idiopathic constipation - antegrade continence enemas - colonic resection - diffuse colonic dysmotility


Publication History

Received: 07 June 2023

Accepted: 21 October 2023

Accepted Manuscript online:
16 November 2023

Article published online:
31 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Cheng LS, Goldstein AM. Surgical management of idiopathic constipation in pediatric patients. Clin Colon Rectal Surg 2018; 31 (02) 89-98
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Siminas S, Losty PD. Current surgical management of pediatric idiopathic constipation: a systematic review of published studies. Ann Surg 2015; 262 (06) 925-933
    CrossrefPubMedSearch in Google Scholar
  • 3 Gladman MA, Scott SM, Lunniss PJ, Williams NS. Systematic review of surgical options for idiopathic megarectum and megacolon. Ann Surg 2005; 241 (04) 562-574
    CrossrefPubMedSearch in Google Scholar
  • 4 Vilanova-Sanchez A, Levitt MA. Surgical interventions for functional constipation: an update. Eur J Pediatr Surg 2020; 30 (05) 413-419
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Villarreal J, Sood M, Zangen T. et al. Colonic diversion for intractable constipation in children: colonic manometry helps guide clinical decisions. J Pediatr Gastroenterol Nutr 2001; 33 (05) 588-591
    CrossrefPubMedSearch in Google Scholar
  • 6 Dolejs SC, Smith Jr JK, Sheplock J, Croffie JM, Rescorla FJ. Contemporary short- and long-term outcomes in patients with unremitting constipation and fecal incontinence treated with an antegrade continence enema. J Pediatr Surg 2017; 52 (01) 79-83
    CrossrefPubMedSearch in Google Scholar
  • 7 Asipu D, Jaffray B. Treatment of severe childhood constipation with restorative proctocolectomy. Arch Dis Child 2010; 95 (11) 867-870
    PubMedSearch in Google Scholar
  • 8 Levitt MA, Martin CA, Falcone Jr RA, Peña A. Transanal rectosigmoid resection for severe intractable idiopathic constipation. J Pediatr Surg 2009; 44 (06) 1285-1290 , discussion 1290–1291
    CrossrefPubMedSearch in Google Scholar
  • 9 Scoglio D, Ahmed Ali U, Fichera A. Surgical treatment of ulcerative colitis: ileorectal vs ileal pouch-anal anastomosis. World J Gastroenterol 2014; 20 (37) 13211-13218
    CrossrefPubMedSearch in Google Scholar
  • 10 van Engelenburg-van Lonkhuyzen ML, Bols EM, Benninga MA, Verwijs WA, Bluijssen NM, de Bie RA. The effect of pelvic physiotherapy on reduction of functional constipation in children: design of a multicentre randomised controlled trial. BMC Pediatr 2013; 13: 112
    CrossrefPubMedSearch in Google Scholar
  • 11 van Engelenburg-van Lonkhuyzen ML, Bols EM, Benninga MA, Verwijs WA, de Bie RA. Effectiveness of pelvic physiotherapy in children with functional constipation compared with standard medical care. Gastroenterology 2017; 152 (01) 82-91
    CrossrefPubMedSearch in Google Scholar
  • 12 Farahmand F, Abedi A, Esmaeili-Dooki MR, Jalilian R, Tabari SM. Pelvic floor muscle exercise for paediatric functional constipation. J Clin Diagn Res 2015; 9 (06) SC16-SC17
    PubMedSearch in Google Scholar
  • 13 Rodriguez L, Heinz N, Nurko S. Utility of colon manometry in guiding therapy and predicting need for surgery in children with defecation disorders. J Pediatr Gastroenterol Nutr 2020; 70 (02) 232-237
    CrossrefPubMedSearch in Google Scholar
  • 14 Rodriguez L, Nurko S, Flores A. Factors associated with successful decrease and discontinuation of antegrade continence enemas (ACE) in children with defecation disorders: a study evaluating the effect of ACE on colon motility. Neurogastroenterol Motil 2013; 25 (02) 140-e81
    CrossrefPubMedSearch in Google Scholar