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Clin Colon Rectal Surg 2018; 31(02): 089-098
DOI: 10.1055/s-0037-1609023
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Surgical Management of Idiopathic Constipation in Pediatric Patients

Lily S. Cheng
1   Department of General Surgery, University of California San Francisco, San Francisco, California
,
Allan M. Goldstein
2   Department of Surgery, Harvard Medical School, Boston, Massachusetts
3   Department of Pediatric Surgery, Massachusetts General Hospital, Boston, Massachusetts
4   MassGeneral Hospital for Children, Boston, Massachusetts
› Author Affiliations
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Publication History

Publication Date:
25 February 2018 (online)

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Abstract

Constipation is a common childhood problem, but an anatomic or physiologic cause is identified in fewer than 5% of children. By definition, idiopathic constipation is a diagnosis of exclusion. Careful clinical evaluation and thoughtful use of imaging and other testing can help exclude specific causes of constipation and guide therapy. Medical management with laxatives is effective for the majority of constipated children. For those patients unresponsive to medications, however, several surgical options can be employed, including anal procedures, antegrade colonic enemas, colorectal resection, and intestinal diversion. Judicious use of these procedures in properly selected patients and based on appropriate preoperative testing can lead to excellent outcomes. This review summarizes the surgical options available for managing refractory constipation in children and provides guidance on how to choose the best procedure for a given patient.

Keywords

constipation - functional constipation - idiopathic constipation - antegrade colonic enemas - colorectal resection