SURGICAL EVALUATION AND MANAGEMENT OF REFRACTORY CONSTIPATION IN OLDER CHILDREN

Chronic constipation is a common childhood problem that accounts for 3 % to 5% of pediatric visits and 10% to 25% of referrals to pediatric; gastroenterologists. The etiology of constipation can be elusive, and extensive investigation often fails to identify a specific cause. The authors conducted a fi-year retrospective review of the patients refer red for deep transanal rectal biopsy to determine the usefulness of th is procedure in the evaluation and subsequent surgical management of r efractory constipation. Specimens obtained by transanal rectal biopsy established a diagnosis for 30 of the 70 patients, and 17 of these 30 had subsequent procedures in the treatment of their constipation. The authors conclude that transanal rectal biopsy identifies a significant number of patients with previously unidentified neuroenteric disorder s who may benefit from additional surgery in the treatment of constipa tion refractory to medical manangement. Copyright (C) 1996 by W.B. Sau nders Company