Treatment of severe childhood constipation with restorative proctocolectomy

Abstract

Objective: To describe the clinical features of children with severe constipation and their outcome after restorative proctocolectomy.

Design: Observational study and health status questionnaire using gastrointestinal quality of life score (GIQL).

Setting: English regional paediatric surgery service.

Patients: Five children were identified, with severe constipation, whose symptoms had not improved with either prolonged medical therapy or colonic lavage using an antegrade colonic enema procedure. All had required a stoma to resolve their constipation. Intervention All underwent restorative proctocolectomy.

Results: All children are stooling through their anus. The mean stool frequency is 6/day. None have daytime incontinence, and none require any further therapy for constipation. Complication rates have been low with no permanent morbidity. The mean GIQL 3 years following restorative proctocolectomy was 89 (SD 29).

Conclusions: In highly selected cases, restorative proctocolectomy may allow resolution of the symptoms of severe constipation and avoid leaving a child with a permanent stoma.