Management of pediatric patients with refractory constipation who fail cecostomy.
BACKGROUND
Antegrade continence enema (ACE) is a recognized therapeutic option in the management of pediatric refractory constipation. Data on the long-term outcome of patients who fail to improve after an ACE-procedure are lacking.


OBJECTIVE
To describe the rate of ACE bowel management failure in pediatric refractory constipation, and the management and long term outcome of these patients.


METHODS
Retrospective analysis of a cohort of patients that underwent ACE-procedure and had at least 3-year-follow-up. Detailed analysis of subsequent treatment and outcome of those patients with a poor functional outcome was performed.


RESULTS
76 patients were included. 12 (16%) failed successful bowel management after ACE requiring additional intervention. Mean follow-up was 66.3 (range 35-95 months) after ACE-procedure. Colonic motility studies demonstrated colonic neuropathy in 7 patients (58%); abnormal motility in 4 patients (33%), and abnormal left-sided colonic motility in 1 patient (9%). All 12 patients were ultimately treated surgically. Nine patients (75%) had marked clinical improvement, whereas 3 patients (25%) continued to have poor function issues at long term follow-up.


CONCLUSIONS
Colonic resection, either segmental or total, led to improvement or resolution of symptoms in the majority of patients who failed cecostomy. However, this is a complex and heterogeneous group and some patients will have continued issues.
Division of Pediatric Gastroenterology, Floating Hospital for Children at Tufts Medical Center. Electronic address: sbonilla@tuftsmedicalcenter.org.
Silvana F
SF
Bonilla
Alejandro
A
Flores
Carl-Christian A
CC
Jackson
Walter J
WJ
Chwals
Bruce A
BA
Orkin
D000293:Adolescent; D000714:Anastomosis, Surgical; D002431:Cecostomy / Q000379:methods / Q000706:statistics & numerical data; D002648:Child; D002908:Chronic Disease; D003082:Colectomy / Q000379:methods; D003106:Colon / Q000294:innervation / Q000503:physiopathology / Q000601:surgery; D003248:Constipation / Q000601:surgery* / Q000628:therapy; D019468:Disease Management; D004733:Enema / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005769:Gastrointestinal Motility; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult
Abdominal pain; Antegrade continence enemas (ACE); Cecostomy; Colonic resection; Constipation; Total colectomy