title: Primary sigmoidectomy and appendicostomy for chronic idiopathic constipation.
abstract: OBJECTIVE
  To present our experience in patients with chronic idiopathic constipation complicated by megarectosigmoid and fecal incontinence who underwent a primary sigmoidectomy and appendicostomy.
  
  
  METHODS
  We reviewed eight patients referred to the Colorectal Center from 2014 to 2016 with chronic idiopathic constipation and undergoing a sigmoidectomy and appendicostomy. We analyzed the previous medical treatment, indications for the surgical procedure, and outcomes.
  
  
  RESULTS
  Age at operation was 5-19 years. Time with constipation was 4-15 years. All patients received multiple laxatives, mainly polyethylene glycol, and all had severe social problems. Four patients have autism. The indication for surgery was an unsuccessful laxative trial, refusal to continue with rectal enemas or both, and social fear of continued fecal incontinence. Post-operatively, all patients were having daily bowel movements without fecal accidents.
  
  
  CONCLUSIONS
  Selected patients with chronic idiopathic constipation complicated by megarectosigmoid and fecal incontinence can obtain great benefit from primary sigmoidectomy and appendicostomy.
authors.affiliation: Colorectal Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, One Children's Hospital Drive, 4401 Penn Avenue, Faculty Pavilion Suite 7135, Pittsburgh, PA, 15224, USA. luis.delatorre@chp.edu.
authors.forename: Luis
authors.initials: L
authors.lastname: De La Torre
authors.affiliation: Colorectal Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, One Children's Hospital Drive, 4401 Penn Avenue, Faculty Pavilion Suite 7135, Pittsburgh, PA, 15224, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Cogley
authors.affiliation: Colorectal Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, One Children's Hospital Drive, 4401 Penn Avenue, Faculty Pavilion Suite 7135, Pittsburgh, PA, 15224, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Calisto
authors.affiliation: Colorectal Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, One Children's Hospital Drive, 4401 Penn Avenue, Faculty Pavilion Suite 7135, Pittsburgh, PA, 15224, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Nace
authors.affiliation: Colorectal Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, One Children's Hospital Drive, 4401 Penn Avenue, Faculty Pavilion Suite 7135, Pittsburgh, PA, 15224, USA.
authors.forename: Catalina
authors.initials: C
authors.lastname: Correa
mesh_terms: D000293:Adolescent; D001065:Appendix / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D012809:Colon, Sigmoid / Q000002:abnormalities / Q000601:surgery*; D003248:Constipation / Q000601:surgery*; D005242:Fecal Incontinence / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008531:Megacolon / Q000601:surgery; D012007:Rectum / Q000002:abnormalities; D055815:Young Adult
keywords: Appendicostomy; Autism; Fecal incontinence; Idiopathic constipation; Megarectosigmoid; Sigmoidectomy