History Of Constipation Research Articles

Six Out of Ten Women with Recurrent Urinary Tract Infections Complain of Distressful Sexual Dysfunction \u2013 A Case-Control Study

Uncomplicated recurrent urinary tract infections (rUTIs) are common among reproductive-aged women. We aimed to assess the prevalence and predictors of sexual dysfunction (FSD) in a cohort of women with rUTIs and compare their psychometric scores to those of matched controls. Data from 147 rUTIs women and 150 healthy controls were analysed. Participants completed the International Prostatic Symptoms Score (IPSS), the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (SDS). Descriptive statistics and logistic regression models tested prevalence and predictors of distressful FSD. Women with rUTIs had lower FSFI scores (p < 0.001) and a greater proportion of pathological FSFI (78.9% vs. 21.4%; p < 0.001) and SDS scores (77.8% vs. 21.4%; p < 0.001) than controls. Of rUTIs patients, 88 (60%), 77 (52.2%), and 75 (51.1%) reported pathological scores for FSFI-pain, lubrication and arousal, respectively; moreover, 64% had concomitant pathological FSFI and SDS scores. Age, IPSS severity, rUTIs, a history of ≥6 UTIs/year and a history of constipation were independent predictors of pathologic FSFI and SDS (all p ≤ 0.05). In conclusion, up to 80% of women with rUTIs showed pathologic FSFI and SDS scores, with 60% reporting scores suggestive of distressful FSD. Having ≥6 UTIs/year and a history of constipation independently predicted distressful FSD.

Proportion of Intestinal Obstruction and Associated Factors Among Patients with non Traumatic Acute Abdomen Admitted to Surgical Ward in Debre Birhan Referral Hospital, North East Ethiopia

Intestinal obstruction (IO) continues to be a major problem for human being since it was first recognized and treated in 350 Before Christ. Different treatment options were developed since then with only minimal reduction in morbidty and mortality. It occurs when the normal flow of intestinal content is interrupted. Intestinal obstruction is the most common causes of emergency surgical admission through out world. It is also one of the major causes of morbidity and mortalities associated with acute abdomen. The proportion and etiologies of intestinal obstruction differ not only from country to country but also with in the different regions of the same country. Knowing proportion of obstruction is very important to manage patients accordingly. Only very few data concerning proportion of intestinal obstruction is found in Ethiopia and none in Debre Birhan. The aim of the study is to assess the proportion of intestinal obstruction and associated factors among patients with non traumatic acute abdomen admitted to surgical ward in Debre Birhan Referral Hospital from December 8,2015 to January 9,2016. Facility based cross-sectional study was conducted by using 357 patient’s record with acute abdomen from December 8,2015 to January 9,2016. Collected data was entered in to SPSS version 20. Adjusted Odds ratio with 95% confidence interval and p-value were used to measure associations. From 357 study subjects 181 (50.7%) and 141 (39.5%) were Intestinal obistruction and acute appendicitis cases respectively with response rate of 99.4%. large bowel obstruction (LBO) accounts for about 109 (60.2%) of cases while 72 (39.8%) of cases were small bowel obstruction (SBO). Male gender, residence and constipation are significantly associated with intestinal obstruction (P&lt;0.05). From all study subjects those who had previous history of constipation were 61 (33.7%), previous history of abdominopelvic operation 25 (7%), previous history of intestinal obstruction 35 (9.8%), hernia 12 (3.4%) and previous history of rectal bleeding 5 (1.4%). Intestinal obstruction is the most common cause for non traumatic acute abdominal admission accounting 50.7%. In the study area Male gender, constipation and urban residence are significantly associated with intestinal obstruction. Postoperative adhesion and garoin hernias were found to be the commonest causes for intestinal obstruction next to Volvulus, but tumor was the rare cause of small bowel obstruction in the study area. Elective repair of hernia should be strengthened before it causes obstruction. Public awareness should be increased on the risk factors of intestinal obstruction through health education to reduce the observed magnitude. Moreover, health facilities and health professionals capable of handling patients with intestinal obstruction should be available with in the reach of the community.

Paediatric Constipation;Think Beyond Thyroid Causes

Introduction: This study was designed to evaluate the importance of proper detailed history and examination of the patient as well as to determine the prevalence of unrecognized hypothyroidism among the paediatric patients with constipation attending the outpatient paediatric units in our hospital.Material and Methods: A retrospective review of medical records of paediatric patients ordered for thyroid function tests between July 2014 and June 2015 was performed. Total of 2210 paediatric patients were included in the study. A complete review of the medical records of these patients were performed which included indications for ordering thyroid tests, medical history, drug history, radiologic evaluation, other laboratory tests and subspeciality consultation.The samples were analyzed in the hormone unit of the Clinical Biochemistry Laboratory by a fully automated analyzer (Cobas e411, Roche). Data analysis was done using SPSS statistical software. Clinical diagnosis was made according to the paediatric reference ranges used in our clinical laboratory. Results: Out of all patients, 149 had history of constipation and 11 patients out of 149 had abnormal thyroid function. Repeat measurements after three months showed normal results for nine, while only two patients had results suggestive of hypothyroidism.Conclusion: Functional constipation is a condition which is to be diagnosed only by history or clinical examination. Thyroid profile where necessary is to be done after proper examination, to reduce the burden of cost to laboratory and society as well as exposing the pediatric patient to trauma.J Nepal Paediatr Soc 2016;36(2):143-146

Factors Associated With Intestinal Constipation in Chronic Patients With Stroke Sequelae Undergoing Rehabilitation.

The objective of this study was to define which stroke-related factors constitute independent variables in the incidence of intestinal constipation (IC) of chronic patients admitted to a hospital rehabilitation program. All patients consecutively admitted for rehabilitation were recruited for the study. In the Poisson multiple regression analysis using a hierarchical model, sociodemographic variables, comorbidities, medication, previous history of constipation, life habits, and stroke-related variables were considered for defining factors associated with IC. A 31% prevalence (95% confidence interval [CI]: 25.3-37.1) of IC was detected. Among the factors associated, female gender (adjusted prevalence ratio [PRadjusted] = 1.79; 95% CI: 1.20-2.68), intestinal complaints prior to stroke (PRadjusted = 3.71; 95% CI: 2.60-5.31), intake of less than 800 ml of fluid per day (PRadjusted = 1.72; 95% CI: 1.20- 2.45), age greater than 65 years at brain injury (PRadjusted = 1.67; 95% CI: 1.01-2.75), and partially impaired anterior brain circulation (PRadjusted = 3.35; 95% CI: 1.02-10.97) were associated with IC. Female gender, elderly, prior history of IC, low fluid intake, and partial impairment of anterior brain circulation were factors independently associated with IC in stroke survivors undergoing rehabilitation. These findings require further validation and may serve toward improving bowel retraining programs for this patient group.

Sigmoid volvulus in children

Fig 1. Abdominal radiograph showing massive dilatation of the whole colon, without signs of intestinal perforation. A 10-YEAR-OLD GIRL was evaluated at the Emergency Department because of a 2-day history of abdominal distension with pain and nonbilious vomiting. She had a 5-year history of chronic constipation, previously diagnosed as functional constipation. On physical examination, her abdomen was massively distended with voluntary guarding. Laboratory evaluation showed an elevated C-reactive protein (24 mg/dL, normal range 0–5 mg/dL). Abdominal radiograph showed a massively dilated colon (Fig 1). A nasogastric tube was placed, and a water-soluble contrast enema was obtained (Fig 2). The enema showed the “twisted taper” or “bird’s beak” configuration of the twisted colon, in which the dilated proximal segment represents the bird’s head, and the tapered distal end its beak. These findings were consistent with the diagnosis of sigmoid volvulus. After an unsuccessful attempt at endoscopic decompression and derotation, the patient underwent an emergency exploratory operation. At laparotomy, 1808 counterclockwise torsion of the sigmoid colon was confirmed. The dilated sigma had a maximal diameter of 17 cm, without sign of ischemia or necrosis. Colonic irrigation with saline solution was performed, and the patient underwent derotation and resection of 25 cm of dilated sigma and primary end-to-end colocolonic anastomosis with sigmoidopexy. Sigmoid volvulus is extremely rare in children and is usually associated with a long-standing history of constipation or pseudo-obstruction. In these patients, redundant sigmoid colon could

A rare cause of intestinal obstruction: dual mesh migration into the small intestine following laparoscopic umbilical hernia repair

The laparoscopic approach is widely accepted worldwide for the management of Umbilical hernias. Here we report a case of intestinal obstruction due to migration of a composite dual mesh into the small intestine after laparoscopic umbilical hernia repair. A case was reported in which, a 50-year-old female patient presented in emergency department with 3 days history of constipation and a clinical picture of intestinal obstruction. She underwent laparoscopic umbilical hernia repair using dual mesh elsewhere 2 years back. As initial conservative management failed, emergency exploratory laparotomy was done which showed adhesions between the ileum and anterior abdominal wall and the mesh had migrated into the intestinal lumen and produced intestinal obstruction. The involved bowel was resected. It was concluded that mechanical small bowel obstruction is an uncommon and rare but possible complication after laparoscopic umbilical hernia repair using dual mesh.

Stercoral Perforation of the Sigmoid Colon: A Case Report

Stercoral perforation is a very dangerous, life-threatening situation that has a high mortality rate, and usually is diagnosed only during exploratory laparotomy. Stercoral perforation, in more than 90% of cases involves the sigmoid colon, resulting from ischemic pressure necrosis of the bowel wall, caused by fecalomas. The exact mechanism that causes fecalomas to form has yet to be defined clearly, but many factors such as a history of constipation, are thought to contribute. I report a rare case of stercoral perforation of sigmoid colon on a 86-year-old man who had been bed ridden because he was paraplegic due to CVA.

Endoscopic management of sigmoid volvulus in children.

Sigmoid volvulus (SV) is extremely uncommon in children and is usually associated with a long-standing history of constipation or pseudo-obstruction. An early diagnosis and management are crucial in order to prevent the appearance of hemorrhagic infarction of the twisted loop, avoiding further complications such as necrosis, perforation and sepsis. In patients with no evidence of peritonitis or ischemic bowel, treatment starts with resuscitation and detorsion of the SV, accomplished by means of sigmoidoscopy and concomitant rectal tube placement. The bowel is then prepared and surgery is undertaken electively during the same hospitalization. We report a detailed review of the literature focusing on technical details, risks and benefits of endoscopic management of SV in childhood.

Fatal Meningitis in a 14-Month-Old with Currarino Triad.

We report a case of a 14-month-old girl with undiagnosed Currarino triad presenting acutely with meningitis caused by enteric commensals. Head CT demonstrated a large pneumocephalus. A fistulous neurenteric tract through a presacral mass was present on spine MRI and abdominal CT. The patient had a history of constipation for the last three months. However, an underlying diagnosis of Currarino triad had not been suspected. In retrospect, a sickle-shaped sacral anomaly was present on a previous abdominal radiograph. The patient succumbed to complications of meningitis. The purpose of the case report is to highlight the potentially fatal complication of Currarino triad and sensitize radiologists to look actively for sacral anomalies on abdominal radiographs, especially of children with chronic constipation.

Fecal Microbiota and Diet of Children with Chronic Constipation.

Many factors explain dysbiosis in chronic constipation (CC), such as a low-fiber diet. The objective of this study was to compare the fecal microbiota of constipated and nonconstipated children and their intake frequencies of food. Methods. This observational study included 79 children (M/F 43/36) aged six to 36 months divided into two groups: cases (39 constipated children) and controls (40 nonconstipated children). We used a structured form to collect demographic variables, conducted anthropometric assessment, and collected food intake frequency data. The fecal microbiota of the stool samples was analyzed by real-time polymerase chain reaction (PCR) using the fluorophore SYBR® Green. Results. Constipated children had a smaller concentration of Lactobacillus per milligram of stool (p = 0.015) than nonconstipated children, but the concentration of Bifidobacterium per milligram of stool (p = 0.323) and the intake of fruits, vegetables (p = 0.563), and junk food (p = 0.093) of the two groups did not differ. Constipated children consumed more dairy products (0.45 ± 0.8; p > 0.001), were more frequently delivered via caesarean section (69.2%), were weaned earlier (median: 120; 60Q1–240Q3), and had a family history of constipation (71.8%). Conclusions. Children with CC have a smaller concentration of Lactobacillus in their stools and consume more dairy products.

Another cutaneous sign of acute pancreatitis.

Sir, A 45-year-old male who was a chronic alcoholic for 20 years was admitted in a state of shock. He had complaints of abdominal pain and vomiting for 10 days duration. There was history of constipation for 3 days. On examination, patient was semiconscious. Pulse rate and blood pressure was 112/min and 80/60 mmHg, respectively. Abdominal examination showed distended abdomen. On palpation, there was guarding and rigidity. On auscultation bowel sounds were absent. There was positive grey turner's sign (ecchymosis of flanks). Another new ecchymosis noted in the right axilla and was deep blue in color [Figure 1]. Figure 1 Ecchymosis noted in the right axilla which was deep blue in colour Investigations showed leukocytosis with elevated liver and renal function test. There was elevated amylase (890 U/L) and lipase (595 U/L) levels. Computed tomography of abdomen showed pancreatic necrosis with peripancreatic fluid collection and peripancreatic fat stranding [Figure 2]. He was diagnosed as acute necrotising pancreatitis. Aspirate negative for gram stain and culture and sensitivity. Hence, patient managed with intravenous fluid, proton pump inhibitor, octerotide infusion, and inotropic support. In due course, he developed desaturation and was intubated. His condition improved with above measures. Ecchymosis in the right axilla started to fade during recovery period. After 15 days, there was a complete disappearance of ecchymosis in the right axilla. Figure 2 Computed tomography of abdomen showed pancreatic necrosis with peripancreatic fluid collection and peripancreatic fat stranding A cutaneous manifestation of pancreatitis is very rare compared to abdominal signs. There are numerous cutaneous sign mentioned in pancreatitis. They are (1) Grey Turner's sign-ecchymosis of flanks, (2) Cullen's sign-ecchymosis around the umbilicus, (3) Fox's sign-ecchymosis of thigh, and (4) Bryant's sign-bluish discoloration of scrotum.[1] Causes of Grey Turner's sign and Cullen's sign includes acute pancreatitis, hemorrhagic pancreatitis, retroperitoneal hemorrhage, blunt abdominal trauma, ruptured ectopic pregnancy, spontaneous bleeding following coagulopathy, ruptured aortic aneurysm, ruptured common bile duct, perforated duodenal ulcer, ruptured hepatocellular carcinoma, hepatic lymphoma, Percutaneous liver biopsy, and rectus sheath hematoma.[2,3] Etiology of Cullen's sign includes formation of methemalbumin in subcutaneous plane due to digested blood around the abdomen from the inflamed pancreas and the blood likely diffuse via the falciform ligament to the subcutaneous tissue around the umbilicus.[4] Etiology of Grey Turner's sign is spread of the pancreatic inflammation from the anterior pararenal space between the posterior renal fascia and subsequently to the lateral edge of the quadrates lumborum muscle.[5] Discoloration of skin in Grey Turner's sign or Cullen's sign varies from blue, purple, green, and yellow color. In our case, there was an ecchymosis found the flanks (Grey Turner's sign) and one more ecchymosis found near the axilla. Axillary ecchymosis appeared as deep blue color. Etiology of ecchymosis in our case was probably due to formation of methemalbumin due to pancreatitis. Our patient had severe necrotising pancreatitis and developed systemic inflammatory response syndrome. Once patient recovered from pancreatitis, the lesion started to fade away. This ecchymosis over the axilla can help to diagnose pancreatitis early. It can also act as an indicator for severity of pancreatitis. It can be considered as a new sign in pancreatitis. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

The prevalence of and factors associated with constipation in elderly residents of long stay institutions

Objective : Constipation is a frequent motility disorder and while a common complaint among the overall population, is particularly prevalent among the elderly. The increase of this population group is creating a growing demand for long term care institutions. The present study aims to investigate the prevalence of and factors associated with constipation in elderly residents of long stay care institutions. Method : The study involved 87 individuals. The data collected from each participant included gender, daily intake of water and fiber, physical activity, family history of constipation and nutritional status. The diagnosis of constipation was based on Roma III criteria. Statistical analysis was performed with the SPSS software program (version 18.0) with a level of significance of 5% (p≤0.05). The Student t, Mann-Whitney, Pearson's chi-square or Fischer's exact tests were employed. Results : The sample was predominantly female (80.5%), with a mean age of 79.4(±9.6) years. A 42.52% prevalence of constipation was observed. Among affected individuals, the condition was more frequent among women (89.2%), those aged over 80 years (67.6%), those who did not engage in physical activity (56.8%), those with below the recommended intake of water and fiber, those who had a family history of constipation, and those who were diagnosed with eutrophia (56.3%). Among the factors analyzed, only age (p=0.049) and low fiber intake (p=0.019) were significantly linked to constipation. Conclusion : The results show that constipation is a multifactorial disease that is significantly related to age and low fiber intake.

C-reactive protein levels in girls with lower urinary tract symptoms

Daytime lower urinary tract (LUT) conditions are identified as daytime incontinence problems for children in whom any cause of neuropathy and uropathy has been excluded. C-reactive protein (CRP) is a common marker of acute or chronic inflammation and infection. Increased CRP levels have been detected in the studies conducted on adults diagnosed with overactive bladders and interstitial cystitis. This study aimed to investigate the role of serum CRP levels in girls suffering from daytime LUT conditions. Out of the 752 patients who presented to the outpatient clinics with lower urinary tract symptoms, 709 were excluded due to: being boys, having previous urinary tract surgery, an active urinary tract infection, a neurological anomaly, a urinary system anomaly, having rheumatic disease, any chronic disease, any febrile infection over the past week, a history of constipation, and enuresis nocturna. Forty-three girls with LUT conditions and aged 8-10 years were included in the study as the patient group. Forty girls who attended the urology outpatient clinic without LUT conditions, or active urinary tract infections and any chronic disease requiring follow-up constituted the control group. Under the control of the parents, all subjects were asked to fill out 3-day voiding diaries. The voiding diaries identified frequency, urgency, urgency urinary incontinence, and functional bladder capacity data. All subjects also completed a dysfunctional voiding scoring system (DVSS). The serum CRP levels of all subjects were measured. There was a significant difference in serum CRP levels and DVSS between the patient group and the control group (P = 0.001, P = 0.001). The mean serum CRP levels showed a significant increase when frequency and urgency scores were ≥8, the urge incontinence score was ≥2 and the DVS score DVSS was ≥14 in the voiding diaries of the patient group (Table). Lower urinary tract dysfunction is defined as a condition involving abnormalities of filling and/or emptying of the bladder. This frequently encountered problem constitutes >40% of all pediatric urology outpatient visits. The relationship between LUT conditions and serum CRP in both genders has been detected. However, it is believed that to our knowledge, this is the first study looking at the relationship between daytime LUTS and increased CRP levels in children. The most important limitations of the study were: having a small number of patients, and the sample consisting of only one gender and a specific age group. The serum CRP levels were significantly higher in the girls with daytime LUT conditions than in the control group. Also, the CRP levels significantly increased as DVSS, frequency, urgency, and urge incontinence scores increased.

Small Intestinal Bacterial Overgrowth (SIBO) and Fungal Overgrowth (SIFO): A Frequent and Unrecognized Complication of Colectomy: ACG Category Award: Presidential Poster

Introduction: Following subtotal colectomy, approximately 40% of patients report abdominal pain and diarrhea, and this is associated with poor quality of life. Its cause is unknown and many are labeled as IBS. In a pilot study, we observed a high incidence of bacterial overgrowth in post-colectomy patients. Our aim was to determine the prevalence of SIBO/SIFO in patients with unexplained GI symptoms following colectomy (> 1 year). Methods: Patients seen between January 2012 to March 2015 with chronic GI complaints and a history of colectomy and negative GI evaluation (endoscopy, blood tests, CT scan) other than post-op changes were assessed and underwent testing for SIBO with either 75 g glucose breath test (GBT) and/or distal duodenal aspiration (DDA). The DDA was performed using aseptic technique with a sterile 6F Liguory nasobiliary catheter, and cultures were obtained for aerobic, anaerobic, and fungal organisms. Bacterial concentrations≥103 cfu/mL was defined as SIBO positive. Results: 50 patients (F/M =41/9; mean age 52.32 years) with prior colectomy were assessed. Of these, 48/50 patients underwent GBT alone, 33 underwent GBT and DDA, and 2 underwent DDA alone. We found that 31/50 patients(62%) had SIBO. 16 subjects with SIBO had aerobic flora (streptococcus and klebsiella spp.), and 11 had anaerobic flora (bacteroides veillonella, and peptostreptococcus spp). In this subgroup 12/31(39%) had concurrent SIFO and 2/50(4%) had SIFO alone—all grew candida. Abdominal pain, gas, bloating, diarrhea, and nausea are common and severe (table1). Patients with SIBO/SIFO had greater symptoms than those without. The indication for subtotal colectomy was constipation(36%), diverticular disease(8%), bowel obstruction(8%), colorectal carcinoma(8%), polyps(6%), other (26%), or not documented (8%). The prevalence of SIBO in patients with history of constipation was 10/18(56%) compared to 22/32(69%) in patients without constipation. Conclusion: Overall 62% of patients with previous colectomy and chronic GI symptoms had undiagnosed SIBO and 39% had concurrent SIFO. SIBO and SIFO are important, frequent, and unrecognized complications following colectomy that explain their persistent gas, bloating, and pain. This occurs either because of small intestinal colonization by colonic flora by translocation through a widely patent ileocolonic anastomosis and/or dysmotility. SIBO/SIFO should be identified and treated in patients with persistent GI symptoms after colectomy, and not mislabeled as IBS.Table 1: Symptom prevalence and severity in patients with SIBO, Mixed SIBO and SIFO, SIFO and no overgrowth

Prevalence, risk factors and severity of symptoms of pelvic organ prolapse among Emirati women.

BackgroundSimilar to other Gulf countries, the society in United Arab Emirates is pro-natal with high parity and high prevalence of macrosomic babies. Therefore, it is possible to have a high prevalence of pelvic organ prolapse (POP). Thus, the aim of this study was to determine the prevalence of POP symptoms in one of the UAE cities.MethodsA cross-sectional study of all women who attended the three family development centres was conducted in Al-Ain from January 2010 to January 2011. Non-Emirati, pregnant and nulliparous women younger than 30 years were excluded.ResultsOut of 482 women who met the inclusion criteria, 429 (89.0 %) agreed to fully participate in the study. 127 women (29.6 %) reported symptoms of POP (mean age: 38.2 years, range: 18–71).Out of the 127 affected women, a dragging lump was felt occasionally in 68 %, sometimes in 19 %, most of times in 9 % and all the times in 4 %. 73 % of affected women experienced soreness in the vagina. Around one third had to insert their fingers in the vagina to either start or complete emptying of the bladder or to empty the bowel.Using multivariate analysis, the independent risk factors were history of constipation, level of education, chronic chest disease, nature of occupation, birth weight and body mass index (Odds ratio; 95 % Confidence interval): (4.1; 2.3-7.3), (1.7; 1.2-2.3), (2.9; 1.6-5.5), (0.5; 0.4-0.8), (1.7; 1.1-2.5), (1.1; 1.0-1.1), respectively (P < 0.05 for all).ConclusionSymptoms of POP are prevalent among Emirati women. Independent risk factors included history of chronic constipation and chest disease, level of education, job type, birth weight and body mass index. Additional healthcare campaigns are required to educate the public regarding these risk factors.Electronic supplementary materialThe online version of this article (doi:10.1186/s12894-015-0062-1) contains supplementary material, which is available to authorized users.

Stercoral Colitis in Two Young Psychiatric Patients Presenting with Abdominal Pain

BackgroundFewer than 150 cases of stercoral colitis have been reported in the literature. Stercoral colitis develops when feces impacts in the colon, resulting in increased luminal pressure, colon wall ulceration, and an inflammatory colitis. Patients are typically over the age of 60 years and have history of constipation. Mortality from colon perforation secondary to stercoral colitis is as high as 60%. Case ReportWe present two male patients, ages 26 and 35 years old, with history of psychiatric illness who presented with constipation and abdominal pain, who were found to have stercoral colitis on computed tomography. One patient developed stercoral perforation of the colon requiring emergent laparotomy. Why Should Emergency Physicians Be Aware of This?Stercoral colitis is a rare but potentially fatal etiology of abdominal pain that should be considered in young patients with history of constipation.

Perforated obturator Littré hernia in an elderly woman

Obturator hernia is an uncommon condition. It carries the highest mortality amongst abdominal wall hernias, usually presenting in elderly, multiparous and thin ladies. Meckel diverticulum is a rare cause of intestinal obstruction and its existence in an obturator hernia is extremely rare; our literature search revealed only two reported cases. We report the case of a 70-year-old woman who presented with signs and symptoms of intestinal obstruction and peritonitis. An exploratory laparotomy led to diagnosis of a strangulated obturator hernia. The sac contents included a Meckel diverticulum with a perforation at its base and a loop of the ileum. The ischemic ileal segment including the Meckel diverticulum was resected and a loop ileostomy was created.

Validation of a bowel dysfunction instrument for adolescents with spina bifida

Existing survey instruments for bowel dysfunction in the pediatric population are either parent-reported or focus on non-neurogenic bowel dysfunction. The purpose of this study was to develop and validate an adolescent-reported survey to assess the severity of bowel dysfunction in spina bifida patients and examine its impact on quality of life (QOL). We performed a cross-sectional study of patients in our Myelodysplasia Program, aged 11-17 years, with a history of constipation and/or fecal incontinence (FI) from November 2010 to June 2013. Control patients, aged 11-17 years, were recruited from the stone clinic. Exclusion criteria were lack of English fluency, insufficient reading skills, or an incontinent fecal diversion. A 29-item version of the Adolescent Fecal Incontinence and Constipation Symptom Index (A-FICSI) was developed with five domains (Figure). Test re-test reliability and correlation with the total global health-related QOL score from the Parkin survey were measured using the Pearson correlation coefficient. A factor analysis model with four-fold correlations was tested. Of the 65 study-eligible individuals approached, 25 (11 boys) completed the A-FICSI (median age 12.6 years, IQR 11.8-14.7 years) and 17 completed another survey on urinary incontinence (64.6% response rate). Twenty-one control patients with nephrolithiasis completed the A-FICSI. Nine of the 25 completed a second administration of the survey. The mean correlation between repeated administrations of the survey was r = 0.43. There was a significant negative correlation between severity of constipation (r = -0.299, p < 0.05) and severity of FI (r = -0.316, p < 0.05) with the total Parkin QOL score. The Comparative Fit Index (CFI) was 0.864. Most items loaded significantly on their respective factors. Between-factor correlations were all significant (>0.30) in the predicted direction. Unstandardized residuals were 8.7% (95% CI 6.4-10.9%). Item reduction was performed on the 29-item instrument based on results of the factor analysis. The finalized instrument contained 21 items. This is the first adolescent-reported bowel dysfunction instrument to undergo formal psychometric assessment in the spina bifida population. The instrument demonstrated adequate reliability and the five-factor structure fit the data well. This study highlights the negative impact of bowel dysfunction on the QOL of spina bifida patients. It is limited by the moderate sample size that is a common issue in relatively rare diseases. The A-FICSI possesses desirable psychometric properties for the measurement of bowel dysfunction in the spina bifida population.

MP54-17 BEYOND VUR GRADING AND SURGICAL TECHNIQUE: PATIENT-BASED PARAMETERS SIGNIFICANT FOR SUCCESS OF ENDOSCOPIC ANTIREFLUX SURGERY

You have accessJournal of UrologyPediatrics: Urinary Tract Infections/Vesicoureteral Reflux1 Apr 2015MP54-17 BEYOND VUR GRADING AND SURGICAL TECHNIQUE: PATIENT-BASED PARAMETERS SIGNIFICANT FOR SUCCESS OF ENDOSCOPIC ANTIREFLUX SURGERY Gina Cambareri, George Chiang, and Madhu Alagiri Gina CambareriGina Cambareri More articles by this author , George ChiangGeorge Chiang More articles by this author , and Madhu AlagiriMadhu Alagiri More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2040AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Successful treatment with dextranomer/hyaluronic acid copolymer, or Deflux®, historically has been quantified by the grade of vesicoureteral reflux present however other factors may determine a successful outcome. Herein we report prognostic factors that may be associated with successful Deflux® outcome. METHODS A retrospective review was performed in children who presented with vesicoureteral reflux (VUR) and underwent Deflux® from 2010-2013. Seven variables were analyzed to assess for prognostic significance including age, amount of Deflux® used, type of VUR (filling vs. voiding), presence of scarring on DMSA, history of bladder bowel dysfunction (based on clinical symptoms and DVSS scores when available), improvement in bladder and bowel dysfunction prior to Deflux® and clinical constipation. RESULTS A total of 301 patients met inclusion criteria for a total of 441 ureters (females 76.4%, average age 50.8 months). There were 55 ureters in grade 1, 151 ureters in grade 2, 195 ureters in grade 3, 31 ureters in grade 4 and 9 ureters in grade 5. Grade 1 VUR did not show significance for any variable on univariate or multivariate analysis. Failure of grade 2 VUR was more likely in children with a history of BBD (p=0.016) and clinical constipation (p=0.002) and more likely to resolve if the patient had improvement in BBD (p=0.001) on univariate analysis. Grade 3 VUR was more likely to fail if there was a history of BBD (p=0.002) and clinical constipation (p=0.001) on univariate analysis. On multivariate analysis patients with a history of BBD were more likely to fail (p = 0.044, OR 0.373). Patients with voiding VUR were more likely to be successful (p = 0.046, OR 2.271). Grades 4 and 5 were analyzed together and older patient age was prognostic of success (p=0.023) on univariate analysis. When analyzing the entire cohort, failure was more likely in patients with a history of BBD (p=0.002) and clinical constipation (p<0.001). Success was more likely in children with improved BBD the time of Deflux® (p<0.001). On multivariate analysis, patients with a history of constipation were more likely to have failed Deflux® (p = 0.006, OR 0.417). VUR on voiding was 1.64 times more likely to resolve successfully after one Deflux® injection (p = 0.043, OR 1.636). CONCLUSIONS We found that history of BBD and clinical constipation were more likely to predict failure in children treated with Deflux®. Children with improved BBD were more likely to benefit from Deflux®. These variables have important prognostic significance when deciding on treatment options in children with VUR. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e671 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gina Cambareri More articles by this author George Chiang More articles by this author Madhu Alagiri More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Frequency and Determinants of Urinary Incontinence in Adolescent and Young Nulliparous Women

Study ObjectiveTo investigate the rate of urinary incontinence (UI) in a sample of young nulligravid women and its potential risk factors and consequences on life habits. Design and ParticipantsThe study is based on an online self-administered questionnaire taken by nulligravid women aged 15 to 25 years. MeasurementsThe Questionnaire for Urinary Incontinence Diagnosis and part of The King's Health Questionnaire. Demographics and general characteristics are also recorded. ResultsWe collected 1936 questionnaires (mean age of participants, 21 years); 12.4% of the sample reported any UI (95% confidence interval [CI] 10.9% to 13.9%). The estimated incidence of UI subtypes was 7.2% (95% CI 6.0% to 8.4%) stress UI, 3.4% (95% CI 2.6% to 4.3%) urge UI, and 1.9% (95% CI 1.3% to 2.6%) mixed UI. Age younger than 19 years and body mass index of 30 kg/m2 or greater were associated in the multivariate analysis with an increased risk of UI. A self-reported history of psychological disorders increased the risk of UI (adjusted odds ratio [AOR] 1.4 and 95% CI 1.1% to 1.9%), without significant differences among the UI subtypes. A current history of constipation (AOR 1.9 and 95% CI 1.3% to 2.6%) and enuresis after the age of 5 also increased the risk of UI (AOR 2.9 and 95% CI 2.0% to 4.3%). ConclusionIn a sample of young nulligravid women, UI was not associated with any chronic risk factor known for elder age, but a prevention program may be proposed to women because of their young age (eg, educational session to promote the proper functioning of the pelvic floor). More detailed analyses are needed to better assess the prevalence of UI and risk factors in young nulligravid women.