OBJECTIVES: To study the clinical efficacy of ultrasound-guided endoscopic retrograde appendicitis therapy in children with appendix-related chronic abdominal pain. METHODS: A retrospective analysis was performed on the medical data of 30 children with the chief complaint of chronic abdominal pain who were admitted from August 2019 to May 2021. All the children were found to have inflammation of the appendix or intracavitary stool and fecalith by ultrasound and underwent ultrasound-guided endoscopic retrograde appendicitis therapy. The medical data for analysis included clinical manifestations, endoscopic findings, white blood cell count, neutrophil percentage, length of hospital stay, and cure rate. RESULTS: Among the 30 children with chronic abdominal pain, there were 13 boys (43%) and 17 girls (57%), with a mean age of (9±3) years (range 3-15 years) at diagnosis. The median duration of the disease was 12 months, and the median length of hospital stay was 3 days. The children had a median white blood cell count of 6.7×10⁹/L and a neutrophil percentage of 50%±13%. Fecalith and a large amount of feces were flushed out of the appendix cavity for 21 children (70%) during surgery. The follow-up rate was 97% (29/30), and the median follow-up time was 11 months (range 5-26 months). Of the 29 children, abdominal pain completely disappeared in 27 children (93%). CONCLUSIONS Ultrasound-guided endoscopic retrograde appendicitis therapy is effective in children with chronic abdominal pain caused by feces or fecalith in the appendix cavity.
Abdominal Pain/etiology* ; Adolescent ; Appendicitis/surgery* ; Appendix/surgery* ; Child ; Child, Preschool ; Fecal Impaction ; Female ; Humans ; Male ; Retrospective Studies ; Ultrasonography, Interventional

Humans ; Diverticulum, Colon ; Fecal Impaction ; Hydrodynamics

PURPOSE: This study aimed to determine which factors are related to perforated appendicitis. We also conducted a survey to identify the causative organism. METHODS: From January 2011 to December 2014, 569 pediatric patients (322 male) younger than 19 years old who underwent an appendectomy due to acute appendicitis at Hallym University Sacred Heart Hospital were enrolled. Patients' medical records were reviewed retrospectively to determine their clinical manifestations, laboratory and imaging results, and pathogens. RESULTS: About 127 patients (22%) had perforated appendicitis. The rate of perforated appendicitis in preschool, late childhood, and adolescent ages were 50%, 27%, and 16.8%, respectively. The risk factors of perforation were high C-reactive protein levels and the presence of appendiceal fecalith (P <0.001). Of the 24 samples of peritoneal fluid and periappendiceal pus that were collected intraoperatively, 16 were culture positive. The most common pathogen was Escherichia coli (n=10), and others were Pseudomonas aeruginosa , Streptococcus spp., and Staphylococcus spp. CONCLUSIONS: The perforation rate of appendicitis among patients younger than 5 years old was 50%, and this decreased in proportion with age. Clinicians should be aware of the possibility of perforation when patients with appendicitis have high C-reactive protein levels or the presence of appendiceal fecalith on imaging.
Adolescent ; Appendectomy ; Appendicitis ; Ascitic Fluid ; C-Reactive Protein ; Child ; Escherichia coli ; Fecal Impaction ; Heart ; Humans ; Medical Records ; Pseudomonas aeruginosa ; Retrospective Studies ; Risk Factors ; Staphylococcus ; Streptococcus ; Suppuration

PURPOSE: To characterize the course of treatment for nonmonosymptomatic enuresis with overactive bladder (OAB) in a real clinical setting. METHODS: Data from 111 OAB patients with moderate to severe enuresis were analyzed. The baseline analysis included a questionnaire, voiding diary, uroflowmetry with postvoid residual urine measurement, and plain abdominal radiography of the kidneys, ureters, and bladder (KUB). Following standard urotherapy for 1 month, anticholinergic medication was administered with or without laxatives. Desmopressin was added if there was a partial response to OAB. Patients were followed every 3 months to evaluate the status of OAB and enuresis. Multivariate analysis was performed to identify predictors associated with the lack of complete response (CR) in enuresis at 12 months. RESULTS: Following 12 months of treatment, 64% and 88% of patients experienced at least partial response in enuresis and OAB, respectively. Urgency improved more quickly than enuresis, supporting the need to address daytime symptoms before enuresis. Seventy-nine patients (71%) had fecal impaction on KUB and/or subjective constipation. The combination of anticholinergics with either laxatives or desmopressin fared better than anticholinergics alone. Daytime incontinence and anticholinergics-only treatment were associated with a lack of CR during 12 months of treatment. CONCLUSIONS: The data confirmed the validity of addressing OAB before treating enuresis. The results of this study also highlight the need to address fecal impaction. Patients should be counseled about the need for a prolonged course of treatment before starting treatment. Anticholinergics should be accompanied with either desmopressin or laxatives for better control of enuresis.
Cholinergic Antagonists ; Constipation ; Deamino Arginine Vasopressin ; Enuresis* ; Fecal Impaction ; Humans ; Kidney ; Laxatives ; Multivariate Analysis ; Radiography, Abdominal ; Ureter ; Urinary Bladder ; Urinary Bladder, Overactive*

PURPOSE: Treatment of chronic constipation and fecal impaction is usually outpatient and requires high or frequent doses of laxatives. However, there are children who fail outpatient treatments, sometimes repeatedly, and are ultimately hospitalized. We sought to compare the characteristics of the children who failed outpatient treatment and needed inpatient treatment vs those who achieved success with outpatient treatment, in an effort to identify attributes that might be associated with a higher likelihood towards hospitalization. METHODS: In this retrospective cohort study, we reviewed the medical records of all patients aged 0 to 21 years, with chronic functional constipation and fecal impaction seen in the pediatric gastroenterology clinic over a period of 2 years. RESULTS: Total of 188 patients met inclusion criteria. While 69.2% were successfully treated outpatient (referred to as the outpatient group), 30.9% failed outpatient treatment and were hospitalized (referred to as the inpatient group). The characteristics of the inpatient group including age at onset of 3.6±3.6 years (p=0.02); black ethnicity (odds ratio [OR] 4.31, 95% confidence interval [95% CI] 2.04–9.09); p < 0.001); prematurity (OR 2.39, 95% CI 1.09–5.26; p=0.02]; developmental delay (OR 2.20, 95% CI 1.12–4.33; p=0.02); overflow incontinence (OR 2.26, 95% CI 1.12–4.53, p=0.02); picky eating habits (OR 2.02, 95% CI 1.00–4.08; p=0.04); number of ROME III criteria met: median 4, interquartile range 3–5 (p=0.04) and 13±13.7 constipation related prior encounters (p=0.001), were significantly different from the outpatient group. CONCLUSION: Identification of these characteristics may be helpful in anticipating challenges and potential barriers to effective outpatient treatment.
Age of Onset ; Child* ; Cohort Studies ; Constipation ; Eating ; Fecal Impaction* ; Gastroenterology ; Hospitalization ; Humans ; Inpatients* ; Laxatives ; Medical Records ; Outpatients* ; Pediatrics ; Retrospective Studies

Inevitable immobilization after surgery on lower extremities can induce chronic constipation. Elderly diabetic women usually express ambiguous gastrointestinal symptoms and signs. We present here a case of panperitonitis developed from severe fecal impaction in an elderly diabetic woman after hand reconstruction using material harvested from the lower extremities. A 68-year-old diabetic female underwent anterolateral thigh free flap and wound revision twice on the left thumb. Three weeks after surgery, she complained about mild abdominal pain though she had daily defecation. Despite encouraging ambulation, her compliance was low. Resection of the sigmoid colon and colostomy were performed after diagnosis with bowel perforation. However, the patient went into septic shock and died with multiorgan failure after the guardians issued a DNR (do not resuscitate) order. For preventing bowel perforation, increased uptake of dietary fiber and early ambulation postoperatively should be encouraged, after even hand surgeries.
Abdominal Pain ; Aged* ; Colon, Sigmoid ; Colostomy ; Compliance ; Constipation ; Defecation ; Diabetes Complications ; Diagnosis ; Dietary Fiber ; Disabled Persons ; Early Ambulation ; Fecal Impaction ; Female ; Free Tissue Flaps* ; Hand ; Humans ; Immobilization* ; Lower Extremity ; Shock, Septic ; Thigh* ; Thumb* ; Walking ; Wounds and Injuries

PURPOSE: The single stage transanal pull-through (SSPT) for Hirschsprung’s disease is becoming the most popular procedure. This single center study compared the result of single stage operation with two-stage operation for Hirschsprung’s disease in neonates. METHODS: We retrospectively reviewed medical records of all patients who were diagnosed as Hirschsprung’s disease and underwent SSPT or two-stage operation operation in Asan Medical Center between January 2003 and July 2014. RESULTS: There were 17 SSPT and 28 two-stage operation. The mean age of SSPT group was 14.2±7.1 days, and the mean age of two-stage operation group was 15.4±8.6 days for stomy formation, and 188.6±36.3 days for Duhamel operation. The operation time of SSPT was shorter than Duhamel operation (145.0±37.0 minutes vs. 193.0±36.0 minutes, p<0.001). The mean follow-up period of SSPT and two-stage operation was 35.5±34.9 months (range, 2-132 months) and 56.6±35.5 months (range, 1-121 months), respectively. Defecation problem rate such as fecal soiling or fecal impaction showed no significant difference between the two groups (p=0.719). Two SSPT patients required botulinum toxin injection due to rectal stenosis. Three patients of SSPT group underwent re-do endorectal pull-through due to remnant aganglionic or hypoganglionic bowel. CONCLUSION: The SSPT showed shorter hospital days. However, few patients experienced rectal stenosis, but were manageable with botulinum toxin injection. The SSPT requires experienced-pathologist, as well as surgeon, because intra-operation pathology reading is critical for appropriate SSPT. SSPT is a feasible and reasonable option to treat Hirschsprung’s disease.
Botulinum Toxins ; Chungcheongnam-do ; Constriction, Pathologic ; Defecation ; Fecal Impaction ; Follow-Up Studies ; Hirschsprung Disease ; Humans ; Infant, Newborn* ; Medical Records ; Pathology ; Retrospective Studies ; Soil

Colorectal fecaloma is hardening of feces into lumps of varying size that is much harder in consistency than a fecal impaction. Complications of colorectal fecaloma include ulceration, bleeding, perforation and obstruction of the colon. Most fecalomas are successfully removed by conservative treatment with laxatives, enemas and rectal evacuation to relieve fecal impaction. When conservative treatments have failed, a surgical intervention may be needed. Herein, we report a case of 4.7 cm sized sigmoid fecaloma showing no response to conservative treatments that was successfully removed by endoscopic fragmentation with Coca-Cola injection instead of surgery.
Adult ; Cola/*chemistry ; Colon, Sigmoid ; Colonoscopy ; Fecal Impaction/*drug therapy ; Female ; Humans ; Laxatives/*therapeutic use ; Radiography, Abdominal ; Tomography, X-Ray Computed

The treatment for constipation should be individualized and dependent on the cause, coexisting morbidities, and patient's cognitive status. Although most cases of constipation respond to conservative treatment, including dietary and life-style changes, or mild laxatives, some patients still complain of consistent symptoms and need an assessment of defecatory dysfunction. There is insufficient evidence to support the use of enemas in chronic constipation, although many clinicians and patients find them useful and effective for the treatment of fecal impaction when used with other modalities. In addition, suppositories can be considered as an initial trial for the treatment of defecatory dysfunction, since they help to initiate or facilitate rectal evacuation. The routine use of enemas is typically discouraged, especially sodium phosphate enemas, although tap-water enemas seem safe for more regular use. Soapsuds enemas are not recommended due to possible rectal mucosal damage.
Constipation* ; Enema* ; Fecal Impaction ; Humans ; Laxatives ; Sodium ; Suppositories*

A fecaloma refers to a mass of accumulated feces that is much harder than a mass associated with fecal impaction. Fecalomas are usually found in the rectosigmoid area. A 10-year-old male with chronic constipation was admitted because of increasing abdominal pain. An abdominal computed tomography scan and a simple abdominal x-ray revealed rapidly evolving mechanical obstruction in the small intestine. Most of the fecalomas are successfully treated by conservative methods such as laxatives, enemas and rectal evacuation. When conservative treatments have failed, surgical intervention may be needed. In this case, an emergency operation was performed and a 4x3x2.5 cm fecaloma was found in the distal ileum. We thus report a case of ileal fecaloma inducing small bowel obstruction in a patient with chronic constipation, who required surgical intervention. When symptoms of acute small intestinal obstruction develop in a patient with chronic constipation, a fecaloma should be considered in differential diagnosis.
Abdominal Pain ; Child ; Constipation ; Diagnosis, Differential ; Emergencies ; Enema ; Fecal Impaction ; Feces ; Humans ; Ileum ; Intestinal Obstruction ; Intestine, Small ; Laxatives ; Male