Persistent Constipation Research Articles

Comprehensive Analysis of the Clinical Outcomes, Lifestyle Impacts, and Family Satisfaction in Hirschsprung's Disease: A Retrospective Cohort Study from a Single Pediatric Surgery Unit

Background: Hirschsprung's disease (HD) is a congenital condition causing functional bowel obstruction. Despite surgical advancements, long-term impacts on patients' quality of life, family dynamics, and satisfaction remain underexplored. This study evaluates the clinical outcomes, lifestyle impacts, and family satisfaction in HD management. Methods: A retrospective cohort study analyzed 127 HD cases managed in a single pediatric surgery unit (2004–2020). Data from medical records, surveys, and structured interviews assessed surgical outcomes, postoperative bowel function, school attendance, dietary adjustments, social anxiety, and family satisfaction. The quantitative analysis utilized SPSS v25.0, with p-values <0.05 considered statistically significant. Results: Patients had a mean age at surgery of 10.6 months; 72.4% were male. Surgical interventions included one-stage pull-through (51.2%) and staged procedures (48.8%). Complications like persistent constipation (26.8%), enterocolitis (15.0%), and redo surgeries (6.3%) were common. Functional outcomes showed that 81.1% achieved good bowel function, while 14.2% required occasional medication. Rural patients faced higher absenteeism (45% vs. 30%) and restrictive dietary changes (50% vs. 35%). Family satisfaction was high (73.2%), with concerns about long-term bowel management (65%), psychosocial impact (38%), and financial burdens (21%). Conclusions: This study highlights the multifaceted challenges of HD management, including disparities in rural vs. urban care, persistent complications, and psychosocial impacts. Recommendations include multidisciplinary care, genetic counseling, family-centered support, and public health interventions tailored to regional needs. These findings advocate for enhanced strategies to improve surgical outcomes, address long-term care challenges, and elevate family satisfaction.

Are We Able to Optimize Outcomes and Predict Complications in Pelvic Floor Surgery With a Better Understanding of Hormonal, Microbial and Other Factors? A Report From the ICI-RS 2024.

Pelvic organ prolapse (POP) is a common condition, affecting women worldwide and is known to have a significant impact on Health Related Quality of Life (HRQoL). Although there are various treatment options available, including pelvic floor muscle training and support pessaries, many women opt for or require surgery, with a lifetime risk of needing surgery of 12%-19%. As with any operation, this does not come without its complications and the reoperation rate following POP surgery is up to 36%. This International Consultation on Incontinence-Research Society (ICI-RS) report aims to look at the different factors which may play a role in objective and subjective outcomes following pelvic floor surgery and to summarize the evidence and uncertainties regarding prediction of POP surgical outcomes, how to optimize them and the tools available to predict them. Research question proposals to further this field have been highlighted. At ICI-RS 2024, the evidence for predicting the outcomes from POP surgery and methods to optimize outcomes were discussed and presented in this paper. There are many reasons why POP surgery may fail, such as variations in lifestyle and occupation, persistent constipation, failure in the perineal body, connective tissue types or the shape of the pelvis. There may also be inherent conditions of the vagina, such as hormonal or microbial features. The literature lacks evidence about the potential use of advanced statistical modeling or supervised machine learning in the development of management plans for patients with POP. Furthermore, future research is needed to determine the role of UDS in the preoperative evaluation of POP patients. High-quality powered studies are required to assess optimization for long-term outcomes of pelvic surgery and then, once these are well established, and possible interventions are elucidated, prediction modeling can have a real impact clinically.

A Critical Review of Qabd (Constipation) in Unani Medicine

Constipation is defined as a condition characterized by difficult or infrequent bowel movements, or the sensation of incomplete defecation. Constipation is difficult to characterize exactly because there are so many different normal bowel patterns. Most people have at least three bowel movements per week; however, the diagnosis of constipation is not solely based on low stool frequency. In Unani medicine, "Qabḍ" is precisely defined as a decline in the function of the large intestine. Some physicians believe that persistent constipation is caused by an overabundance of black bile (Sawdā) in the body. Therefore, treating constipation by reducing the excess Sawdā is regarded as crucial. Diagnosis primarily relies on clinical signs and symptoms, supplemented by the Rome II criteria, the Constipation Severity Index, and various constipation scoring systems. Additional specific investigations may also be employed as needed. Keywords: Constipation; Qabd; Iḥtibāsal-Baṭn; Mullayin; Unani medicine.

Association between dietary vitamin B6 intake and constipation: a population-based study.

Numerous studies have suggested a link between dietary micronutrient intake and the onset of constipation. Nevertheless, there has not been much research done on the potential relationship between vitamin B6 and constipation. The purpose of this study was to determine whether dietary vitamin B6 consumption and chronic constipation are related among adult participants in the National Health and Nutrition Examination Survey (NHANES). The study made use of information from the 2009-2010 NHANES health and nutrition survey. Respondents' dietary information was gathered using 24-h dietary recalls. A range of statistical techniques, including as interaction tests, subgroup analyses, and curve fitting analyses, were used to examine the connection between dietary vitamin B6 intake and chronic constipation. This study included 3,643 patients, with 270 (7.41%) diagnosed with persistent constipation. A fully adjusted multiple logistic regression analysis found that increasing dietary vitamin B6 consumption (OR = 0.78, 95% CI: 0.68-0.89) was linked to a lower incidence of constipation, with significance at p < 0.05. After accounting for numerous factors, the odds ratio and 95% confidence interval for the third tertile compared to the reference group (first tertile) were 0.85 (0.74, 0.98), with statistical significance at p < 0.05. Furthermore, subgroup analysis and interaction assessments revealed a substantial negative link between vitamin B6 intake and the occurrence of constipation, particularly in males and alcohol drinkers (all p-values were less than 0.05). This study found an inverse connection between vitamin B6 consumption and the prevalence of persistent constipation. More extensive prospective trials are needed to fully examine the long-term influence of vitamin B6 on persistent constipation.

Transanal Endorectal Pull-Through for Hirschsprung's Disease: Complications and Lessons from Our Practice and the Literature.

Hirschsprung's disease (HD) is a congenital disorder characterised by the absence of ganglion cells in the distal bowel, resulting in functional obstruction. The transanal endorectal pull-through (TEPT) procedure, a minimally invasive approach, aims to treat HD by removing the aganglionic segment. This study assessed the feasibility, safety, and efficacy of single-stage TEPT in paediatric patients, focusing on postoperative complications, bowel function, and quality of life. A retrospective cohort study was conducted on 150 children who underwent single-stage TEPT from January 2005 to December 2023 at the Medical University of Gdansk. Data were collected from medical records, including demographics, preoperative assessments, surgical details, postoperative management, and follow-up outcomes. Statistical analyses were performed using Microsoft Excel 365 and the programming language Python 3.12. The mean age at surgery was 13 months, with a male-to-female ratio of 2.75:1. The mean operative time was 129 min, and the mean hospital stay was seven days. Postoperative complications included anastomotic leak (4%), wound infections (15%), and enterocolitis (26%). Redo surgeries were required in 18% of cases due to persistent constipation and obstructive symptoms. This article includes a comprehensive review of the literature. TEPT demonstrates a favourable safety profile and efficacy in treating HD, though significant concerns include complications such as enterocolitis and the need for additional surgeries. Surgical expertise and thorough preoperative and postoperative management are crucial to optimising patient outcomes.

Aetiology, pathogenetic factors and prevalence of anal fissure in the Republic of Tajikistan

Aim. To study the aetiology, pathogenetic factors and prevalence of anal fissure in the Republic of Tajikistan.Materials and methods. Approximately 600 patients with anal fissure are treated annually in specialized coloproctology centres of the Republic. During 2018-2022, 3,065 patients were admitted with this pathology. All patients underwent perianal examination. Anal and rectal reflexes were measured, digital rectal examination, sphincterometry, manometry and sigmoidoscopy were performed.Results and discussion. The main factor in the pathogenesis is the formation of the so-called vicious cycle, in which the pain factor and spasm of the anal sphincter play an important role, as well as the formation of a caruncle, which was observed in 83% and 82% of the cases, respectively. Pectinosis of the anal sphincter occurred in 8% and thickening of the anal fissure margins in 115 cases.Conclusions. Anal fissure is a polyetiological disease and an important factor in its development is mechanical damage of the posterior wall due to chronic persistent constipation. In the pathogenesis of anal fissure there is a vicious circle in which pain factor and spasm of anal sphincter play an important role.

Clues for Early Diagnosis of MEN2B Syndrome Before Medullary Thyroid Carcinoma.

Early onset medullary thyroid carcinoma, later pheochromocytomas, and nonspecific extra-endocrine features (hypermobility and persistent constipation) are part of the clinical phenotype of Multiple Endocrine Neoplasia type 2B (MEN2B). A de novo pathogenic M918T variant in the rearranged during transfection proto-oncogene is usually identified. Affected children are often seen by multiple clinicians over a long period before consideration of a diagnosis of MEN2B, with metastatic medullary thyroid carcinoma often the precipitator. We describe the clinical presentation and course of 5 children ultimately diagnosed with MEN2B in New South Wales and the Australian Capital Territory, Australia between 1989 and 2021. All cases had intestinal ganglioneuromatosis that could have prompted an earlier diagnosis. Population wide newborn genomic screening for rare diseases is on the horizon. We propose that MEN2B genomic screening should be included in newborn screening programs and that careful exclusion of intestinal ganglioneuromatosis would allow earlier identification leading to improved clinical outcomes.

Drawn Stories Technique: Method and Concluding TherapeuticTurn

Summary The developmental age is often characterized by problems of somatization of psychological problems and conflicts: Anorexia, enuresis, encopresis and persistent constipation. The Drawn-Story (DS) technique presented in this article was developed to enhance and support the narrative-dialogic relationship in the psychodiagnostic and psychotherapeutic context – initially primarily for work with children of developmental age, but later also for other patient groups. It is a projective drawing technique that was developed by Giancarlo Trombini in the 1970s based on his training in Gestalt psychology and psychoanalysis at the University of Bologna and has since been further developed by him, Elena Trombini and their colleagues and also used in other fields of application. This article uses an early case history of DS to explore central aspects of this technique in greater depth. It also explores the question of whether the Concluding Therapeutic Turn observed in therapies with adults can also be observed in developmental age therapy according to the criterion of reconciliation of time perspectives.

Оптимізація хірургічного лікування природженого анального та ректального стенозів у дітей

Congenital anal (CAS) and rectal stenosis (CRS) are variants of anorectal malformations (ARM) in children. Aim - to evaluate the results of surgical correction of CAS and CRS, based on this, to develop the main tactical requirements for the treatment of this complex pathology in children. Materials and methods. The study included 18 children with congenital anorectal stenosis: 7 (38.9%) - with CAS, 11 (61.1%) - with CRS, which accounted for 11.7% of all treated anorectal anomalies (n=154). The ratio of boys to girls was 5:1. After complex diagnostics, in 44.4% (n=8) of children were found to have associated malformations: 42.9% (n=3) of patients with CAS and 45.5% (n=5) - with CRS. Results. All (n=7) patients with CAS underwent one-stage surgical correction, without complications. In 90.9% (n=10) of children with CRS staged surgical treatment was performed, and one-stage in 9.1% (n=1). At the stages of primary correction of CRS postoperative complications occurred in 18.2% (n=2): stoma stenosis (n=1); urethro-perineal fistula (n=1), which were surgically corrected. After the primary correction of CRS was completed, persistent constipation was noted in 2 (18.2%) children. Repeated staged reconstructive operations were performed on these patients. Conclusions. The use of the diagnostic, treatment and rehabilitation algorithm for CRS, developed in the clinic, made it possible to obtain good results in the long postoperative period in 63.6% (n=7) of children, and satisfactory results in 36.4% (n=4). The improved technique of surgical treatment of CAS made it possible to carry out primary correction of the defect with a good functional result in 71.4% (n=5) and satisfactory results in 28.6% (n=2) of children. The research was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research. The authors declare no conflict of interest.

Dealing with the Unexpected: Stercoral Perforation – A Surgical Conundrum

Stercoral colon perforation is a rare surgical emergency primarily linked to chronic constipation and advanced age. Diagnosis is challenging and requires established criteria and imaging. Urgent surgery is the modality of choice, typically involving Hartmann's procedure. Mortality rates can be as high as 60%, emphasising the need for early diagnosis and intervention. We presented a case of a 71-year-old bedridden female with a history of stroke, diabetes, and hypertension presenting with abdominal pain, fever and diarrhoea. Initial evaluation indicated dehydration, sepsis, and abdominal tenderness. An urgent imaging revealed a suspected rectal perforation, prompting emergency surgery. Intraoperatively, stercoral perforation due to impacted hard faeces was identified. Despite prompt and intensive treatment, the patient's condition deteriorated, ultimately resulting in her demise. Stercoral colon perforation is a critical condition requiring rapid diagnosis. Symptoms include abdominal distension, tenderness, cramps, fever, and anorectal pain. Healthcare providers should consider the possibility of stercoral perforation in individuals exhibiting these symptoms alongside a background of persistent constipation. Treatment involves peritoneal lavage and surgery. Early recognition is vital for proper management and improved outcomes.

Small Bowel Obstruction Due to Abdominal Cocoon Syndrome in Post-COVID-19 Patients.

Abdominal cocoon syndrome, also recognized as encapsulating peritoneal sclerosis, is an exceedingly rare medical condition characterized by an anomalous membranous envelopment of the small bowel. Despite its clinical rarity, the precise etiology and pathogenic mechanisms of this syndrome remain elusive. This comprehensive discussion presents a case series encompassing six patients who sought medical attention in the Emergency Room, all sharing a common presentation: severe abdominal distension and persistent constipation. Intriguingly, these symptoms manifested following recent severe coronavirus disease 2019 (COVID-19) infections. Remarkably, none of these patients had significant medical histories or had undergone prior surgical interventions, rendering their cases even more enigmatic. The defining feature across all six cases emerged during exploratory laparotomy, where a consistent finding stunned the surgical team: the discovery of a thick, fibrous membrane enveloping segments of the small bowel. The surgical procedure entailed meticulous dissection and subsequent removal of this membrane, with tissue samples dispatched for histopathological evaluation. This diagnostic approach conclusively confirmed the presence of abdominal cocoon syndrome in each of these patients. The focal point of our discussion revolves around a potential connection between recent severe COVID-19 infection, intensive care unit admissions, and the subsequent development of abdominal cocoon syndrome. This intriguing association compels further inquiry to unveil the precise pathogenesis of this syndrome, particularly within the context of COVID-19. Given the diagnostic complexities associated with abdominal cocoon syndrome, this report underscores the indispensability of maintaining a heightened clinical suspicion and the significance of rigorous intraoperative assessments to ensure timely diagnosis and effective management. Abdominal cocoon syndrome represents a rare and enigmatic medical condition characterized by its uncertain etiology. Our case series tantalizingly suggests a link between recent severe COVID-19 infection and the development of this syndrome. Nevertheless, comprehensive research endeavors are warranted to unravel the intricate mechanisms that underlie this intriguing association. In light of the diagnostic challenges associated with abdominal cocoon syndrome, this report underscores the pivotal role of exploratory surgery, in the absence of definitive radiological imaging, as the cornerstone for both diagnosis and therapeutic intervention. The pursuit of further investigations into the intricate relationship between COVID-19 and abdominal cocoon syndrome may ultimately yield the critical insights needed to demystify this complex medical enigma.

Complementary and alternative medicine (CAM) is frequently used by parents for the treatment of functional constipation in children.

Complementary and alternative medicine (CAM) has gained increasing attention as a supportive treatment for chronic diseases such as epilepsy, migraine, autism, and cancer in children. This study aimed to determine the frequency, motivation, and outcomes of CAM in children with functional constipation. From January 2018 till September 2019, parents of patients (0-18 years) who were treated for functional constipation (ROME IV-criteria) at our colorectal center were asked to complete a questionnaire on the utilization of CAM. Demographic data and clinical assessments were documented and analyzed for patients with and without CAM treatment. A total of 115 patients were included (mean age: 5.1 years; 49% males), of whom 29 (25%) used CAM as an alternative (4/29,14%) or in addition to conventional therapy (CT), including osteopathy (48%), homeopathy (45%), and natural/herbal remedies (17%). The main reason parents reported for the use of CAM was the urge to leave no treatment option unattempted (76%). Multivariate analysis also identified persistent constipation under CT (72%), adverse effects of CT (24%), and parental use of CAM themselves (83%) as independent variables associated with CAM use. Parents reported positive changes in stool frequency (38%) and fecal incontinence (21%) with CAM. The vast majority (93%) plan to use CAM in the future, and even non-CAM users showed high interest (60%). One in four children with functional constipation receives CAM. Significant improvement in stool frequency and continence is missing in the majority. However, parental interest in CAM remains high. Physicians should be aware of CAM when counseling families for functional constipation in children.

Anorectal malformation: Audit of management in a major tertiary institution in Ghana

BackgroundAnorectal malformation (ARM) remains a significant challenge to the child and paediatric surgeons. Its rarity is relative in Sub-Saharan Africa, where there are few specialized centres for management. This study aimed to describe the presentations, management, and preliminary outcomes of ARM in a major specialized centre. MethodsA prospective observational study, with a two-year follow-up was conducted for children (up to 15 years) who presented with ARM at the Paediatric Surgery Unit between November 2020 and July 2021. ResultsSixty-one (61) patients (M: F = 1:0.96) were studied. 28.27 % of the ARM's were detected on day one of birth. More than two thirds of the cohort (70.5 %) was first detected by mothers. The remainder (29.5 %) were detected by health professionals. Majority, 88.2 %, presented late (>24hours). 34(55.4 %) presented in a stable state, 20(32.79 %) with acute intestinal obstruction and 4(6.56 %) with sepsis. Associated congenital anomalies were observed in 7(11.48 %) of patients. All the children had a staged procedure (colostomy, PSARP and closure of colostomy). The mean duration between colostomy creation and PSARP was 7.02 +/- 2.05 months, while the mean duration between PSARP and colostomy reversal was eight months. The complication and mortality rates after all the staged procedures were 39.3 % and 2.2 %, respectively. 5.2 % had persistent faecal soiling while 3.5 % had persistent constipation at 2 years. There were no anal strictures or rectal prolapse. ConclusionSurgical outcomes of children with ARM are generally good, although there were late and unstable presentations to the hospital. Late identification of ARM by health professionals lead to late presentation.

Hemorrhoids the Clinical Practice

Hemorrhoids, commonly referred to as piles, constitute an everyday medical condition characterized by swollen and inflamed vascular systems in the anal canal. This discomfort is a source of pain for numerous individuals worldwide, affecting their satisfaction with their lives. The etiology of hemorrhoids encompasses various factors, including improved intra-stomach stress, persistent constipation, extended sitting, and pregnancy. In addition to being frequently benign, hemorrhoids can cause signs and symptoms including rectal bleeding, anal itching, pain, and prolapse. This summary explores the modern-day understanding of hemorrhoids, emphasizing their classification into internal and external types, based on their anatomical location and signs. Inner hemorrhoids originate above the dentate line and are typically painless. However, they can also cause bleeding and prolapse. Outside hemorrhoids located under the dentate line can be painful and thrombosed. Diagnostic approaches embody scientific record evaluation, bodily examination, and every so often anoscopy or sigmoidoscopy to exclude more serious conditions. The management of hemorrhoids consists of lifestyle modifications along with elevated dietary fiber consumption, hydration, and normal exercise to relieve constipation and decrease intra-abdominal stress. Topical treatments consisting of corticosteroids and over-the-counter ointments offer relief from signs and symptoms. For refractory cases, minimally invasive procedures such as rubber band ligation, sclerotherapy, and infrared coagulation offer powerful solutions. Surgical interventions, such as hemorrhoidectomy, are reserved for severe instances or when other treatments are ineffective.

Late Diagnosis of Hirschsprung Disease: Clinical Presentation and Long-Term Functional Outcomes

PurposeHirschsprung Disease (HD) is typically diagnosed in the neonatal period. A small subset of patients have a prolonged course of abdominal distention and constipation prior to diagnosis. Late HD is defined as having been diagnosed at greater than or equal to one year of age. The literature is limited and offers conflicting data on the implications of a late diagnosis. We aim to investigate the presentation, operative approach, and functional outcomes of a large cohort of patients with a late HD diagnosis. MethodsAll patients with a late diagnosis of HD (after 1 year of age) at our institution between 1997 and 2021 were included. ResultsTwenty-eight patients were diagnosed with HD at a median age of 3.4 years. Chronic constipation, failure to thrive, and enterocolitis occurred in 100 %, 31 %, and 14 %, respectively. All patients underwent contrast enema and biopsies during their workup, identifying primarily rectosigmoid disease (n = 27) and total colonic aganglionosis (n = 1). Surgical intervention was performed in 27 patients, with 4 patients (15 %) needing a stoma (3 with plan for staged pull-through, 1 long-term stoma) and 23 patients (85 %) undergoing a single-stage pull-through. Postoperative complications included Hirschsprung-associated enterocolitis (n = 5), ostomy prolapse and revision (n = 2), abdominal distention requiring ileostomy creation (n = 2), redo pull-through (n = 2), retroperitoneal hematoma (n = 1), and cecostomy tube placement (n = 1). At a median follow-up of 5.4 years, 83 % of eligible patients achieved fecal continence with 43 % needing laxatives for persistent constipation. ConclusionRecognizing a late presentation of HD requires a high index of suspicion. Patients with a late diagnosis did not experience an increased rate of permanent stoma, complications, or redo surgery compared to rates reported for the larger HD population. Similar long-term functional outcomes were achieved compared to the larger HD population. Level of EvidenceIV.

Synchronous colorectal cancer: a case report

Synchronous colorectal cancer (CRCs) refers to more than 1 primary CRCs detected in a single patient simultaneously or within 6 months of the initial diagnosis. A 76-year-old men presented with persistent constipation since 1 month ago. Abdominal computed tomography (CT) showed an irregular mass in the right lower middle abdomen. Intraoperatively, the synchronous CRCs was found, therefore a subtotal colectomy was performed and the diagnosis was confirmed by histopathological examination. Synchronous CRCs is relatively rare. The CT can detect tumor, node, and metastasis (TNM) staging of colon cancer. Extensive resection was performed taking into account the patients preferences, number and location of tumors and postoperative plan. Surgeons should be familiar with all standard colorectal tumor surgical procedures, to avoid technical difficulties when surgical plans are changed for incidentaloma resection. Failure to identify synchronous colorectal carcinoma before surgery can lead to inadequate therapeutic procedures.

Nodular Lymphoid Hyperplasia of the Colon in an Adult Patient after Covid-19 Infection: A Case Report and Literature Review

Nodular lymphoid hyperplasia of the colon (NLHC) is an uncommon pathology in adults. The disease can be asymptomatic and discovered incidentally or symptomatic, which is often manifested by abdominal pain and motility disorders (diarrhea, constipation). The clinical presentation can also be alarming with rectal bleeding and obstructive symptoms that may be misinterpreted as a neoplastic process. In this paper, we report the case of a 58-year-old female patient with a previous history of appendicetomy. She presented with persistent abdominal pain, chronic constipation and black colored stools, following Covid-19 infection. The physical examination was unremarkable. Colonoscopy examination found a bulging, non-ulcerated mass, measuring 3.5 cm in greatest dimension, located at the right colic angle. Thoraco-abdomino-pelvic computed tomography was performed and showed right colonic wall thickening and enhanced nodule formation. Furthermore, metastatic localization was not detected. After a multidisciplinary meeting, a laparotomy with right hemicolectomy was performed. Histopathological examination of the surgical specimen revealed nodular lymphoid hyperplasia with CD20+, CD5−, CD10+ and BCL2− phenotype on immunohistochemistry. Besides, lymphocytes in interfollicular area are CD3+ T cells. Patient outcome was favorable after surgery and no additional treatment was necessary. Nodular lymphoid hyperplasia of the colon is a benign process whose endoscopic appearance can sometimes raise suspicion of malignancy. The diagnosis can only be established by histological evaluation. Immunohistochemistry is also essential to confirm the diagnosis and to rule out low-grade lymphoma. Clinical evolution is often favorable. However, endoscopic follow-up is necessary in all cases.

FEATURES OF THE CLINICAL COURSE AND COMPLEX TREATMENT OF HEMORRHOIDS IN CHILDREN

The aim: to analyze the current state of the issue of hemorrhoid disease in children of different age on the basisof first-hand experience.Materials and methods: author conducted examinations in 71 children with hemorrhoids: general clinical,laboratory, rectal finger, anoscopy, rectoscopy and additional research complexes. There were 56 (78,8%) boys and15 (21,2%) girls.Results and discussion: The features of the cause of the disease, clinical manifestation, course, localization havebeen studied and tactical treatment approaches in the age aspect have been developed. In infants, a common cause ofhemorrhoids were: a two-stage act of defecation with increased diarrheal syndrome; in children of early and preschoolage, periodic and prolonged potty sitting and congenital inferiority of the venous network of the small pelvis in schoolage children played an important role. The frequency of occurrence is more marked in preschool age – 71.7%. Theexternal form of hemorrhoids was revealed – in 90% and combined – in 10% of sick children. Frequent localizationof hemorrhoids occurred in children at 4 o'clock (35%) and 7 o'clock (30%).Comprehensive treatment of hemorrhoids in children was carried out: conservative - in 34 (83%) and surgical - in7 (17%) patients. In infancy and early age, the complex of conservative treatment included: treatment of the mainprimary disease (ChD, diarrheal syndrome, pathology of the colon, etc.) and local treatment; in preschool children- the use of medical enemas and rectal suppositories, ointments and the use of SCL, LL and school and older age- treatment of ChD. Indications for the operation were: the presence of large varicose nodes that violate the act ofdefecation, inflammation, prolapse, infringement and constantly falling out nodes and causing pain. In children, moregentle surgical methods are used. Surgical treatment is more susceptible to school age. There were no complicationsin the postoperative period.Conclusions. 1. Persistent constipation is a common cause of hemorrhoids in children; increased diarrhea, atwo-stage act of defecation, tension in sports, tense cough and urination are also causes of hemorrhoids.2. The clinical features of the course of hemorrhoids in children 1-3 years old is the transient nature of the coursein 70% of cases.3. Hemorrhoids are often found in children of preschool age, with the absence of pain and bleeding.4. The most frequent (65%) localization is 4 and 7 on the clock face.5. In children under 3 years of age with hemorrhoids, only conservative treatment is an effective method. Surgicaltreatment is more susceptible to school age.6. Indications for hemorrhoid surgery in children are: the presence of large varicose nodes that violate the act ofdefecation, inflammation, prolapse, infringement, as well as easily or constantly falling out nodes and causing pain.

Primary Trans-anal Endorectal Pull Through for The Management of Hirschsprung Disease: Our Experience of 20 Cases

Hirschsprung’s disease can be defined in terms of the aganglionic part of the colon and the definitive treatment is a one-stage trans-anal endorectal pull-through surgery. Objectives: To find out the efficacy and safety of this one-stage pull-through. Mostly the surgery is done in early childhood or the neonatal period, as the case is less frequently reported in older children and adolescents. Methods: A retrospective study was conducted including 16 males and 4 females. 20 cases including children of 6 months to 14 years, all were diagnosed with Hirschsprung’s disease in the study duration of two years. The diagnostic criteria of these patients included; Clinical history of delayed passage of meconium, contrast enema, and rectal biopsy. Definitive variables were; Age, sex, and length of the aganglionic part of the colon. Results: All the patients included in the study had distended abdomens and persistent constipation. All of them have an aganglionic colon, a diagnosing feature of Hirschsprung’s disease. All patients underwent the trans-anal endorectal one-stage pull-through. The average operative time recorded was 150 minutes. Post-operative complications were also recorded including anastomosis leakage (only in one case; for that a diversion colostomy was done), anastomotic stenosis or stricture (not reported in any case), enterocolitis and perineum irritation (In four cases), Transient fecal incontinence is a major complication (11 cases had transient fecal incontinence which resolved spontaneously with 1 to 2 weeks). No death had been recorded. Conclusion: For the treatment of Hirschsprung’s disease, primary trans-anal endorectal pull-through is a safe and efficient technique.

Caudal regression syndrome with duplication of the inferior vena cava presenting with chronic constipation

Caudal regression syndrome is an uncommon congenital disease that occurs when a portion of the vertebral column and spinal cord fails to grow properly. Although the exact reason has yet to be determined, the link to maternal diabetes is well recognized. This spinal anomaly can thus be reduced clinically to simple coccygeal agenesis with no deficit or even lumbosacral agenesis with sphincter problems, transit disorders, and different lower limb impairments. We report this case of a 13-year-old girl who was born to a diabetic mother and suffered from persistent constipation. On radiological exploration, she was discovered to have abnormalities compatible with caudal regression syndrome, we also noticed a duplication of the inferior vena cava, this association was never described in the literature.