Presenter Status
Resident/Ph.D/Post graduate (> 1 month of dedicated research time)
Abstract Type
Research
Primary Mentor
Rebecca M. Rentea, MD, MS
Start Date
12-5-2023 11:30 AM
End Date
12-5-2023 1:30 PM
Presentation Type
Poster-Restricted Access
Description
Background: Anorectal malformations (ARMs) occur in 1 in every 5000 newborns. Up to 79% of patients with an ARM experience constipation and/or soiling after a primary posterior sagittal anorectoplasty (PSARP) and are referred to a bowel management program. Understanding the potential for bowel control and protocols for diagnosing and managing these children have changed over the last years.
Objectives/Goal: We aim to report the recent updates in evaluating and managing ARM patients as part of the manuscript series on current bowel management protocols for patients with colorectal diseases (ARMs, Hirschsprung disease, functional constipation, and spinal anomalies).
Methods/Design: The literature review was performed using the Medline/PubMed database, focusing on manuscripts and books published over the last 5 years. Sixty of the selected articles were included in the current review. Search keywords included: anorectal malformation, bowel management, constipation, fecal incontinence, and potential for continence.
Results: ARM patients have unique anatomic features, such as a maldeveloped sphincter complex, impaired anal sensation, and associated spine and sacrum anomalies. Before bowel management initiation, evaluation is required to exclude anatomic causes of stooling issues and predict the potential for bowel control. The evaluation protocol includes an examination under anesthesia and a contrast study. The potential for bowel control is assessed with a sacral radiogram and spinal ultrasound or MRI. The likelihood of continence is discussed with the families based on the ARM index calculated from the quality of the spine and sacrum. The bowel management options include stimulant laxatives, fiber, rectal enemas, transanal irrigations, and antegrade continence enemas. ARM patients require formed stools; thus, stool softeners should be avoided as they can worsen soiling. Senna-based laxatives were proven to be safe. Sigmoid resection may be required. A redo PSARP for anatomic causes of constipation/soiling can be performed with a simultaneous antegrade continence enema procedure based on the patient’s potential for continence.
Conclusions: There are several key recent updates in bowel management of patients with an ARM, focusing on anatomic considerations, the potential for continence, bowel management options and strategies, and a role of a redo PSARP in the improvement of bowel control.
MeSH Keywords
bowel management/anorectal malformation/imperforate anus/fecal incontinence/enema/laxatives/constipation
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State-of-the-Art Bowel Management for Pediatric Colorectal Problems: Anorectal Malformations
Background: Anorectal malformations (ARMs) occur in 1 in every 5000 newborns. Up to 79% of patients with an ARM experience constipation and/or soiling after a primary posterior sagittal anorectoplasty (PSARP) and are referred to a bowel management program. Understanding the potential for bowel control and protocols for diagnosing and managing these children have changed over the last years.
Objectives/Goal: We aim to report the recent updates in evaluating and managing ARM patients as part of the manuscript series on current bowel management protocols for patients with colorectal diseases (ARMs, Hirschsprung disease, functional constipation, and spinal anomalies).
Methods/Design: The literature review was performed using the Medline/PubMed database, focusing on manuscripts and books published over the last 5 years. Sixty of the selected articles were included in the current review. Search keywords included: anorectal malformation, bowel management, constipation, fecal incontinence, and potential for continence.
Results: ARM patients have unique anatomic features, such as a maldeveloped sphincter complex, impaired anal sensation, and associated spine and sacrum anomalies. Before bowel management initiation, evaluation is required to exclude anatomic causes of stooling issues and predict the potential for bowel control. The evaluation protocol includes an examination under anesthesia and a contrast study. The potential for bowel control is assessed with a sacral radiogram and spinal ultrasound or MRI. The likelihood of continence is discussed with the families based on the ARM index calculated from the quality of the spine and sacrum. The bowel management options include stimulant laxatives, fiber, rectal enemas, transanal irrigations, and antegrade continence enemas. ARM patients require formed stools; thus, stool softeners should be avoided as they can worsen soiling. Senna-based laxatives were proven to be safe. Sigmoid resection may be required. A redo PSARP for anatomic causes of constipation/soiling can be performed with a simultaneous antegrade continence enema procedure based on the patient’s potential for continence.
Conclusions: There are several key recent updates in bowel management of patients with an ARM, focusing on anatomic considerations, the potential for continence, bowel management options and strategies, and a role of a redo PSARP in the improvement of bowel control.
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