title: Management of chronic intractable constipation in children.
abstract: BACKGROUND
  Chronic intractable constipation (CIC) is a debilitating disease that is challenging to manage. Treatment options in children include medications, enemas, and surgical management in selected cases.
  
  
  METHODS
  We reviewed medical records of pediatric patients diagnosed as having CIC at Tufts Medical Center from 2005 to 2012. Demographic variables, diagnostic procedures, and medical and surgical outcomes were collected. Clinical outcome was defined using the Rome III criteria.
  
  
  RESULTS
  A total of 14 patients were included in the study (10 boys). The age range was 10 to 21 years. All of the patients had the diagnosis of CIC. Eleven patients had cecostomy placement. During the follow-up period, 10 patients underwent total abdominal colectomy with ileorectal anastomosis, 1 had total colectomy with ileostomy, and 1 had partial colectomy with colorectal anastomosis. Successful clinical outcome was reported in 7 patients with 3 patients reporting persistent fecal incontinence. Colonic motility studies were performed on 12 patients (colonic neuropathy in 11 patients and normal study in 1 patient). Defecography was consistent with isolated pelvic floor dysfunction in 1 patient, abnormal motility and anatomy in 1 patient, pelvic floor dysfunction and abnormal motility in 2 patients, and found abnormal motility only in 5. Defecography study was normal in 5 patients. All of the patients with abnormal colonic manometry underwent a surgical procedure.
  
  
  CONCLUSIONS
  Anorectal manometry, colonic manometry, and defecography help in understanding the pathophysiology of defecation disorders in children. The majority of patients with abnormal colonic manometry underwent TAC-IRA. There was no statistical correlation between individual investigations (anorectal manometry, colonic manometry, and defecography) with surgical intervention (P > 0.35). TAC-IRA may be safe and useful intervention in a subset of patients when other treatment options have failed.
authors.affiliation: *Pediatric Hospitalist Division, Floating Hospital for Children †Department of Pathology and Laboratory Medicine, Tufts Medical Center ‡Division of Pediatric Gastroenterology, Floating Hospital for Children, Boston, MA §Department of Colorectal Surgery, Rush University Medical Center Chicago, IL ||Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA.
authors.forename: Basavaraj
authors.initials: B
authors.lastname: Kerur
authors.forename: Kanchan
authors.initials: K
authors.lastname: Kantekure
authors.forename: Silvana
authors.initials: S
authors.lastname: Bonilla
authors.forename: Bruce
authors.initials: B
authors.lastname: Orkin
authors.forename: Alejandro F
authors.initials: AF
authors.lastname: Flores
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical; D002431:Cecostomy; D002648:Child; D002908:Chronic Disease; D003082:Colectomy; D003106:Colon / Q000503:physiopathology; D003248:Constipation / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D019841:Defecography; D005242:Fecal Incontinence; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D007081:Ileostomy; D008297:Male; D008365:Manometry / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult