title: A successful treatment strategy in infants and adolescents with anorectal malformation and incontinence with combined hydrocolonic ultrasound and bowel management.
abstract: OBJECTIVE
  Patients with anorectal malformation (ARM) frequently suffer postoperatively from fecal incontinence (25%) and constipation (75%). Depending on the type of malformation, some cases will not have a chance to control bowel movements. For these patients with fecal incontinence, we started to combine bowel management with hydrocolonic ultrasound to keep them clean.
  
  
  METHODS
  From January 2003 until December 2010, overall 63 patients (aged 4-22 years) with ARM and fecal incontinence were treated by specific bowel management. Hydrocolonic ultrasound was used as a diagnostic parameter to determine stool texture and activity of the colon as well as to determine the appropriate volume which is needed to clean the colon. Each patient received an individually adjusted enema. Patients were classified into two groups: Group I: patients with incontinence and tendency to constipation and Group II: patients with incontinence and tendency to diarrhea. Subsequent controls were focused on problems such as bowel dilatation, bowel motility, constipation or too little enema due to the patient's growing.
  
  
  RESULTS
  Up to now, 63 patients were investigated in our study (Group I n = 37 patients and Group II n = 26 patients). In addition, the patients were classified according to the type of malformation. With specific bowel management combined with hydrocolonic ultrasound, 97% of patients in Group I (36/37) stayed clean (demonstration of complete bowel control). All 57.7% of patients in Group II (15/26) stayed clean after daily bowel management, and 34.6% with smearing less than three times per week (n = 9/26). In addition, a specific diet and constipating medication were often necessary to get patients in Group II clean.
  
  
  CONCLUSIONS
  Treating young patients with fecal incontinence is always a challenge. Hydrocolonic ultrasound diagnostically conclusive and less invasive. The combination with bowel management results in better bowel control and serves as a valuable tool in affected infants and adolescents. Thus, hydrocolonic ultrasound may be an essential instrument in postoperative diagnostic procedure and therapy of patients with fecal incontinence.
authors.affiliation: Pediatric Surgery Unit, Department of Surgery, University of Wuerzburg, Oberdürrbacher Strasse 6, 97080, Wuerzburg, Germany. Grasshoff_S@chirurgie.uni-wuerzburg.de
authors.forename: Sabine
authors.initials: S
authors.lastname: Grasshoff-Derr
authors.forename: Kathrin
authors.initials: K
authors.lastname: Backhaus
authors.forename: Désirée
authors.initials: D
authors.lastname: Hubert
authors.forename: Thomas
authors.initials: T
authors.lastname: Meyer
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000002:abnormalities*; D002648:Child; D002675:Child, Preschool; D004065:Digestive System Abnormalities / Q000601:surgery; D005242:Fecal Incontinence / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D012003:Rectal Fistula; D012007:Rectum / Q000002:abnormalities*; D014463:Ultrasonography; D055815:Young Adult