Diagnosis and treatment of colonic stenosis in children: a report of 3 cases and literature review

Abstract

Objective To explore the feasibility, diagnosis and treatment of colonic stricture in children. Methods Three children of sigmoid stenosis were hospitalized from July 2008 to July 2018. Their clinical data were retrospectively analyzed. There were 2 boys and 1 girl with an age range of 9 to 25 months. The literatures of clinical characteristics and surgical treatments of pediatric colonic stenosis were retrieved from the databases of PubMed, Wanfang and application document delivery. The key words included colonic stenosis, colonic stricture and child. The literature cutoff period started from January 1968 to November 2018. Results One case with a previous history of neonatal necrotizing enterocolitis (NEC) had sigmoid stenosis and terminal ileum stenosis. Among another two cases of congenital sigmoid stenosis, one was associated with coagulation abnormalities. All 3 cases were operated for acute intestinal obstruction. One case underwent colonic stenosis resection with end-to-end anastomosis while the remainder were operated in stages. The first stage was stenotomy plus proximal enterostomy and the second stage closure of fistula. All children recovered well postoperatively and no complication occurred during follow-ups. The retrieved literatures were divided into congenital and acquired colonic stenosis groups. In congenital colonic stenosis group, 19 articles were retrieved and 22 cases were reported. The operative stages were I (9/22, 41%) and II (4/22, 18%). The remainder was not described. A total of 31 literatures were retrieved in pediatric acquired colonic stenosis group (n=180) and NEC acquired colonic stenosis group (n=158). Conclusions Colonic stenosis is clinically rare and its etiology is due to congenital and acquired causes. The acquired cause is predominantly NEC. The clinical presentation depends upon the severity of stenosis. The selection of treatments is dependent upon age of onset, degree of stenosis, location and presence/absence of complications. Sigmoid stricture resection may be completed by one-stage end-to-end anastomosis or staged enterostomy. And staged operation is reserved for multiple colonic stenoses. Key words: Colonic diseases; Stenosis; Child