Fecal Incontinence and Constipation in Children: Case Studies PDF
Preview Fecal Incontinence and Constipation in Children: Case Studies
Fecal Incontinence and Constipation in Children Case Studies Fecal Incontinence and Constipation in Children Case Studies Edited by Onnalisa Nash, MS, CPNP Center for Colorectal and Pelvic Reconstruction Surgery Nationwide Children’s Hospital Columbus, Ohio, USA Julie M. Choueiki, MSN, RN, CPEN Center for Colorectal and Pelvic Reconstruction Surgery Nationwide Children’s Hospital Columbus, Ohio, USA Marc A. Levitt, MD Center for Colorectal and Pelvic Reconstruction Surgery Nationwide Children’s Hospital The Ohio State University Columbus, Ohio, USA CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2020 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed on acid-free paper International Standard Book Number-13: 978-0-367-15161-4 (Paperback) 978-0-367-15180-5 (Hardback) This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily reflect the views/opinions of the publishers. The information or guid- ance contained in this book is intended for use by medical, scientific or health-care professionals and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, pro- cedures or diagnoses should be independently verified. The reader is strongly urged to consult the relevant national drug formulary and the drug companies’ and device or material manufacturers’ printed instructions, and their websites, before administering or utilizing any of the drugs, devices or materials mentioned in this book. 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For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://www.copyright. com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for- profit organization that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Contents Preface ix Contributors xi Acknowledgments xiii PART I BOWEL MANAGEMENT 1 1 General guidelines for bowel management 2 Stephanie J. Vyrostek 2 Bowel management program setup: The basics and long-term follow-up 6 Stephanie J. Vyrostek and Laura J. Weaver PART II ANORECTAL MALFORMATIONS 11 3 A patient with good surgical anatomy after an anorectal malformation (ARM) repair with good potential for bowel control 13 Erin M. Shann 4 A patient with good surgical anatomy following an anorectal malformation (ARM) repair with fair potential for bowel control 19 Erin M. Shann 5 A patient with a good anatomic anorectal malformation (ARM) repair, but with poor potential for bowel control 26 Catherine Trimble 6 A patient with a history of a cloacal malformation who needs colorectal, urological, and gynecological collaboration 30 Kristina Booth 7 A young adult with prior surgery for an anorectal malformation (ARM) with fecal incontinence 35 Onnalisa Nash 8 A patient with an anorectal malformation (ARM) with fecal incontinence who is a candidate for a sacral nerve stimulator (SNS) 38 Catherine Trimble PART III HIRSCHSPRUNG DISEASE 43 9 A patient with good surgical anatomy and hypomotility after a Hirschsprung pull-through 46 Leah Moore 10 A patient with good surgical anatomy and hypermotility after a redo pull-through for Hirschsprung disease 49 Leah Moore 11 A child with Hirschsprung disease (HD) and hypomotility 53 Lindsay Reilly v Contents 12 A patient with total colonic Hirschsprung disease and soiling 57 Stacie Leeper 13 A teenager with prior surgery for Hirschsprung disease who has constipation 62 Stacie Leeper PART IV SPINAL ANOMALIES 67 14 A patient with a hypodeveloped sacrum and fecal and urinary incontinence 68 Cassie do Carmo 15 A patient with a spinal anomaly and fecal incontinence 73 Cassie do Carmo 16 A pediatric patient with spina bifida in need of a urological reconstruction 76 Cheryl Baxter 17 A young adult with quadriplegia and fecal incontinence due to spinal cord injury (SCI) 79 Cheryl Baxter PART V FUNCTIONAL CONSTIPATION 83 18 A case of diffuse colonic dysmotility 85 Sarah Driesbach 19 A patient with chronic constipation and sphincter dysfunction 93 Sarah Driesbach 20 A patient with severe functional constipation, fecal impaction, and no soiling 98 Julie Zipfel and Marc A. Levitt 21 A patient with severe functional constipation, fecal impaction, and soiling 102 Julie Zipfel and Marc A. Levitt 22 A patient with a successful rectal enema regimen but who now is unable to tolerate rectal administration 108 Andrea Wagner 23 A patient with severe functional constipation who has failed laxative treatment and both rectal and antegrade enemas 112 Julie Gerberick 24 A patient who has recurrent constipation and soiling following colonic resection 120 Andrea Wagner 25 A young adult with intractable constipation and diffuse colonic dysmotility 124 Alessandra Gasior and Amber Traugott 26 A young adult with pelvic floor dyssynergia 126 Alessandra Gasior and Amber Traugott 27 A patient with severe constipation and a behavioral disorder 128 Katrina Hall, Charae Keys, and Rose Lucey Schroedl 28 A young adult with incontinence after a low anterior resection 132 Alicia Finn, Scott Lake, and Amber Traugott 29 Two adults with incontinence after childbirth 135 Stephanie Dolan, Amber Traugott, and Pooja Zahora 30 A young adult with rectal pain and fecal urgency who is a candidate for sacral nerve stimulation 141 Alessandra Gasior and Amber Traugott vi Contents 31 An adult with soiling following an ileoanal pouch 144 Alicia Finn and Amber Traugott PART VI RADIOLOGY 149 32 Which X-ray is worse? 150 Onnalisa Nash 33 Interesting radiological findings 156 Onnalisa Nash and Marc A. Levitt PART VII MYTHS 163 34 Colorectal surgical myths 164 Julie M. Choueiki PART VIII MEDICATION PROTOCOLS 173 35 Medication protocols 174 Meghan Fisher and Onnalisa Nash Index 183 vii Preface Patients with anorectal malformations (ARMs), Hirschsprung disease (HD), fecal incontinence from a variety of conditions, and colonic motility disorders often require care from specialists across a variety of fields throughout their lives. These include colorectal surgery, urology, gynecology, and GI motility, as well as orthopedics, neurosurgery, anesthesia, pathology, radiology, psychology, social work, and nutrition, amongst many others. Perhaps most important to their achievement of a good functional result is their connection to superb nursing care. Having met many parents with newborns diagnosed with colorectal problems, I have made several observations. First, no parent ever thinks their child could have a problem with stooling—this is a physiologic ability that is taken for granted. When told this is a problem, they are usually shocked. Second, when discussing with parents that their child will need surgery to correct their colorectal anatomy, they do not focus on the surgical technique and elegance of the anal reconstruction, as I do. Instead, they focus on whether that technique will allow their child to stool without difficulty, and whether school, sleep overs, and overnight camp will be options for them. As surgeons, we need to remember this—we always need to understand what it is that the family wishes for us to deliver to them. As proud of our surgical skills as we are, it is the functional outcome that matters most to our patients. I like to say that a complex colorectal operation takes about 4 hours to perform, but in order to get a good result, it takes an additional 96 hours of work—the vast majority of which involves nursing care. From the very beginning of my journey in the field of pediatric colorectal surgery, which began in 1992 as a budding medical student, the value of a good nursing partner became clear to me. Patients and their families tell nurses things they would never tell their doctors. Nurses have a spirit about them that is unique—the genuine devotion to helping their patient and never seeming to want anything in return other than the patient’s smile. Their skills in identifying problems, solving them, being willing to get down in the weeds, and always striving to fill the gaps are unique to the profession. We have attempted in this book to capture some of these special moments represented in the illustrated cases you are about to encounter. We strove to help other caregivers understand the daily struggle of improving a patient’s quality of life and to convey to the readers of this book the skills and tricks to achieve good results. I am so convinced, and often shout from the rooftops that, without my nursing partners, I would have achieved very little as a surgeon. It was an honor ix
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