Surgically treated intractable constipation in children evaluated with colonic manometry

Abstract

Background‘Intractable constipation’ (IC) is constipation unresponsive to 3 months of optimal conventional treatment. Colonic manometry (CM) is recommended as a diagnostic modality for evaluation of these children. This study aimed to review outcomes of children with IC who were managed surgically at a single tertiary care center. MethodsRecords of children with IC who were treated with ACE (antegrade colonic enema), colostomy, or ileostomy (2006–2018) were reviewed. “Success” was defined as adequate evacuation without need for further unplanned surgery. Data are median (range). ResultsSixty-seven children underwent surgery, of whom 56 with preoperative CM were included. Age at surgery was 8.6 (3.3–15.1) years. Eight had normal manometry and underwent ACE with 75% success. Thirty-six had left-sided dysfunction and underwent ACE (18), colostomy (14) or ileostomy (4) as initial intervention with 61, 70, and 100% success. Twelve with pancolonic dysfunction underwent ACE (6) or ileostomy (6) with 60 and 100% success. Twenty underwent repeat manometry 2.2 years (10 months–7.6 years) after surgery. Of 18 with stoma, 8 had resolution or improvement and of these, 7 underwent stoma reversal with a simultaneous ACE. Two patients with ACE had improvement, 1 is still on ACE washouts, and 1 is off all treatment. Ten with persistent dysfunction remain diverted. At 3.2 years (4 months–9.9 years) follow-up, 18 remain on ACE washouts, 9 have colostomy, 19 ileostomy, and 10 are off treatment and doing well. ConclusionWe present a large series of patients who were surgically managed for IC. CM may guide therapy in these children. Type of studyRetrospective comparative study Level of evidenceLevel III.