title: Diarrhea after resection of advanced abdominal neuroblastoma: a common management problem.
abstract: BACKGROUND
  After resection of advanced abdominal neuroblastoma, children may have persistent postoperative diarrhea. Until recently, the magnitude of this problem had not been appreciated.
  
  
  METHODS
  To assess the incidence, severity, and management of chronic postoperative diarrhea in these patients, we reviewed the case notes of all children with stage III or IV abdominal and pelvic neuroblastoma who underwent tumor resection in our hospital between January 1985 and September 1996. We classified the severity of diarrhea as follows: mild, less than 3 loose stools per day; moderate, 3 to 5 loose stools per day; and severe, more than 5 loose stools per day and/or urgency, incontinence, or nocturnal diarrhea.
  
  
  RESULTS
  Seventy-seven children underwent resection during this period, and 23 (30%) had postoperative diarrhea, classified as mild in 11 patients, moderate in 7, and severe in 5. Dissection around the superior mesenteric and celiac arteries was associated with a significantly higher incidence of diarrhea. Fifteen children (65%) received treatment with loperamide, which reduced but did not abolish symptoms. Twelve children subsequently died of progressive neuroblastoma. Of the 11 surviving children (mean duration of follow-up, 8.4 years), 8 have persistent loose stools.
  
  
  CONCLUSIONS
  Diarrhea, probably resulting from disruption of the autonomic nerve supply to the gut during clearance of tumor from the major vessels of the retroperitoneum, is common after resection of advanced abdominal neuroblastoma. Many children require long-term treatment to slow intestinal peristalsis, and a few have severe and unremitting diarrhea. More effective medical management of this complication is needed.
authors.affiliation: Department of Haematology/Oncology, Great Ormond Street Hospital for Children NHS Trust, London, U.K.
authors.forename: H
authors.initials: H
authors.lastname: Rees
authors.forename: M A
authors.initials: MA
authors.lastname: Markley
authors.forename: E M
authors.initials: EM
authors.lastname: Kiely
authors.forename: A
authors.initials: A
authors.lastname: Pierro
authors.forename: J
authors.initials: J
authors.lastname: Pritchard
mesh_terms: D000008:Abdominal Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D000930:Antidiarrheals / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008139:Loperamide / Q000627:therapeutic use; D009447:Neuroblastoma / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000930:Antidiarrheals; D008139:Loperamide