title: Management of severe constipation in children.
abstract: OBJECTIVE
  Constipation is a common pediatric problem. Sometimes the hospitalization is necessary and in these patients the organic cause should be verified. The authors report their experience in the management of children with severe constipation.
  
  
  METHODS
  Anorectal manometry (ARM) was performed after a careful examination of perineum and bowel disimpaction. Once organic cause had be excluded, the patient got medical therapy. If recto-anal inhibitory reflex (RAIR) was absent, not collaborative patient or medical treatment failed, the child underwent contrast enema (CE) and rectal suction biopsies (RSB). Local anesthetics were used for anal fissures or internal anal sphincter (IAS) hypertonia. Anal malformations and Hirschsprung's disease (HD) were surgically treated. Posterior sagittal anorectoplasty was performed for anal malformations.
  
  
  RESULTS
  In 5 years 98 children (63 males) were observed (mean age 6 years). 5 children were premature for gestational age, 4 presented failure to thrive, 5 anal malformations and 45 anal fissures. ARM was performed in 87 children and 74 of them showed normal RAIR. Hypertonia of the IAS was recorded in 38 patients. RAIR was absent/unclear in 13 patients. Follow-up revealed 6 patients (negative to ARM) with poor results without oral laxative. CE was performed in 19 children (2 positive cases) and RBS in 25 patients (2 cases of HD).
  
  
  CONCLUSIONS
  Children with severe constipation must be carefully observed and studied because of not negligible incidence of organic cause. The first step in the management of these patients is the evacuation of the fecaloma.
authors.affiliation: Academic Children's Hospital, Ancona, Italy. carmine.noviello@libero.it
authors.forename: C
authors.initials: C
authors.lastname: Noviello
authors.forename: M
authors.initials: M
authors.lastname: Romano
authors.forename: A
authors.initials: A
authors.lastname: Zangari
authors.forename: A
authors.initials: A
authors.lastname: Papparella
authors.forename: A
authors.initials: A
authors.lastname: Martino
authors.forename: G
authors.initials: G
authors.lastname: Cobellis
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index