Colostomy for treatment of functional constipation in children: a preliminary report.
OBJECTIVE
Surgery is indicated in very few children with intractable functional constipation. A number of operations have been described with unpredictable outcome and significant morbidity. The authors present a series of 10 children who underwent a Hartmann procedure with end colostomy formation.


METHODS
Preoperative management, in addition to maximum conservative measures, included psychologic referral, rectal biopsy, transit studies, and contrast enemas. A standard Hartmann procedure was performed with on-table rectal washout, formation of a proximal sigmoid colostomy, limited anterior resection of hypertrophic proximal rectosigmoid, and oversewing of the rectal stump.


RESULTS
The series includes 10 pediatric patients (4 female, 6 male), in whom constipation was first reported at a median age of 3 years (range, 2 months-7 years) and surgical referral was made at 8 years (range, 1-14 years). Surgery was performed at a median age of 9.5 years (range, 2-15 years), and the median postoperative stay was 5 days (range, 4-9 days). Complications occurred in four patients (transient mild rectal discharge in 2, stomal prolapse in 1, and an unrelated small bowel obstruction in 1 patient with an additional Mitrofanoff stoma). Median postoperative follow-up was 31 months (range, 9-56 months), and the children and parents were all completely satisfied with the stoma.


CONCLUSIONS
Colostomy formation is a potential surgical option for severe functional constipation with low associated morbidity and high patient satisfaction.
Woodward
Mark N
MN
Department of Paediatric Surgery, Bristol Royal Hospital for Children, United Kingdom. mark.woodward@doctors.org.uk
Foley
Peter
P
Cusick
Eleri L
EL
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000473:pathology / Q000601:surgery*; D003125:Colostomy / Q000379:methods*; D003248:Constipation / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D011788:Quality of Life; D016896:Treatment Outcome