Pediatria pre prax 1/2003
Diferenciální diagnostika a možnosti chirurgického léčení chronické zácpy v dětském věku
DIFFERENTIAL DIAGNOSIS AND POSSIBILITIES FOR THE SURGICAL TREATMENT OF CHRONIC OBSTIPATION IN CHILDREN – A REVIEW Chronic obstipation is defined as a disorder of defaecation, when the time interval between a single defaecation is longer than three days and the duration of this condition is more than three months. An accompanying symptom of obstipation is chronic constipation, which is not in itself a disease. An understanding of the cause and successful therapy of chronic obstipation thus consists of diagnosis and treatment of the underlying disease. Several causes of chronic obstipation are the following: mechanical obstruction of the anorectal region, bowel movement disorders and disorders of the anorectal sphincter complex, psychogenic disorders. Surgically treatable causes of chronic constipation in children are: Hirschsprung´s disease, anorectal malformations, rectal duplications, sacrococcygeal teratomas, rectal diverticula and syndrome of fixed spinal cord. A child with chronic constipation must be examined very carefully, especially with regard to the anal and perineal region. When an anal fissure is present, only the anal orifice is inspected, an inspection of the anal canal and rectal ampulla being postponed until after the release of any painful rectal spasm. In children with long lasting constipation a comparison is made between age and weight, height and state of nourishment of the child; the levels of TSH and calcium are determined; a neurological examination, including an X-ray of the lumbosacral spine, is carried out and a urodynamic examination, in the case of enuresis or abnormal shape of sacrum, is performed. Ultrasound examination of the abdominal cavity and retroperitoneum is a necessity. An irrigographic examination is indicated after consultation with the specialist to whom the child was referred. This examination ought to be carried out by a paediatric radiologist in a well- equipped department, where additional evaluation, including magnetic resonance imaging, can be performed. Primary biofeedback therapy and other rehabilitation treatments are indicated after a psychogenic cause of obstipation has been sufficiently verified. We can utilize spa therapy in some indicated cases. Key words: chronic constipation, encopresis, pseudoincontinence, Hirschsprung’s disease, anorectal malformations.
