Surgical Constipation

[size=6]A 4-year-old with a history of perineal anoplasty for a recto-perineal fistula presents with longstanding constipation. The anoplasty is well situated within the sphincter complex without a stricture. X-rays demonstrate copious stool throughout the colon. The most appropriate first step in bowel management for this patient is: a Manual disimpaction b Initiate weight-based daily senna c Exam under anesthesia d Start a psyllium-based fiber supplement e Water-soluble contrast enema study[/size]

Any one want a high quality PDF of this chart, post in this thread, use a personalized picture as an avatar, and have three threads in the forums, I will send it to you in a private message Edit: available without restrictions [center][/center]

quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns - "When medical management fails to resolve constipation, patients with neurogenic or neuromuscular causes of chronic constipation, anorectal malformations, and patients with idiopathic CIC utilize daily enemas to achieve evacuation. Adherence to a regular bowel management program can achieve social continence for many of these patients, but as they grow older, it becomes more convenient for them to be able to manage enema administration independently. In these patients, ACE administration has been demonstrated to improve quality of life [9, 10]…

[size=20px]A six-year old boy has a history of chronic constipation. He passed meconium within 24 hours of life and maintained regular defecation until age 3, but since then has required chronic laxatives and enemas to allow evacuation of stool. A contrast enema shows no evidence of a transition zone. High resolution anal manometry shows failure of internal anal sphincter relaxation with rectal distention. A full thickness rectal biopsy two cm proximal to the dentate line demonstrates normal ganglion cells. The next step in management should be: A Colostomy B Internal sphincter myectomy C Transanal pullthrough D Antegrade colonic enema (ACE) procedure E Int…

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[size=20px]The best way to find out if the colon of the patient is clean after the administration of an enema is by: a- measuring the amount of stool that came out b- palpating the abdomen c- rectal examination d- taking an abdominal X-ray film e- patient become more comfortable[/size]

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[size=20px]A two-year old boy has a history of chronic constipation. He passed meconium within 24 hours of life. However, he has required chronic laxatives and enemas to allow evacuation of stool. A contrast enema shows no evidence of a transition zone. Anal manometry shows failure of internal anal sphincter relaxation after rectal distention. A full thickness rectal biopsy two cm proximal to the dentate line shows no ganglion cells with increased acetylcholinesterase activity while a biopsy 4.5 cm proximal to the dentate line shows ganglion cells. The child has a transient response to a botulinum toxin injection. The next best step in management of this constipated pa…

First one with correct answer with justification win. [size=20px]A five-year old boy had an anorectal malformation repaired at birth. He was started on a bowel management program and had a very good response to dwell enemas, but tolerated them poorly and developed recurrent soiling and constipation when enemas were discontinued Which of the following would be an appropriate next step for a child with encopresis? A Colostomy B Ileostomy C Appendicostomy D Sigmoid colectomy E Proctectomy[/size]