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Constipation
Compiled from across the library · built automatically
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
If the enema volume reaches the cecum, it should be as effective at cleaning the whole colon as a Malone antegrade enema. — Stephanie, Bowel Management - Use Of Ultrasound To Monitor Effects Of Enema · 10:30
Bowel Management - Use Of Ultrasound To Monitor Effects Of Enema
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video12:53 · Nov 2018
If the enema volume reaches the cecum, it should be as effective at cleaning the whole colon as a Malone antegrade enema. — Stephanie, Use of hydrocolonic sonography to monitor the effects of an enema: Pediatric... · 11:10
Bowel Management - Bowel Management In Communities With Limited Resources
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video9:14 · Nov 2018
Use of hydrocolonic sonography to monitor the effects of an enema: Pediatric...
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During the Pediatric Bowel Management Course in 2013,directors DrsAndrea Bischoff, Alberto Peña and Todd Ponsky discusscontroversial/hot topics surrounding the management and diagnosis of pediatric bowel conditions.In this session, Dr. Stef
video12:46 · Jan 2019
Sacral neuromodulation delivers electrical impulses through a probe placed near the sacral nerve to improve quality of life in patients with constipation and fecal incontinence Sacral Nerve Stimulator Placement: A Novel Surgical Navigation Tool for... · 0:00
Tricks - New Duhamel - Laparoscopic Trans-rectal Rectosigmoidectomy
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Dr. Cristobal Abello and his group in Colombia discuss the new Duhamel procedure, covering background and technique for Laparoscopic Trans-rectal Rectosigmoidectomy, followed by a panel discussion.
video10:29 · Nov 2018
Laparoscopic Duhamel: Pediatric Surgery Difficult Cases 2013
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During the Pediatric Surgery Difficult Cases: Innovation Solutions Course in 2014, Drs Cristobal Abello Munarriz, Ricardo Cure Dau, Deborah Dropcho, Oscar Osario present laparoscopic Duhamel procedure technique, with subsequent panel discus
video10:29 · Jan 2019
Sacral Nerve Stimulator Placement: A Novel Surgical Navigation Tool for...
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This video demonstrates an image-guided technique for sacral nerve stimulator insertion by Dr. Jason Frischer at Cincinnati Children's Hospital Medical Center in Cincinnati, OH. This type of neuromodulation is used as an adjunct in the mana
video4:59 · Jul 2019
Increased age at diagnosis was associated with an increased risk of constipation or incontinence requiring intervention postoperatively. — Alex Halpern, Does Delayed Diagnosis of Hirschsprung Disease Impact Post-operative and Functional Outcomes? A Multi-Center Review From the Pediatric Colorectal and Pelvic Learning Consortium · 0:39
Does Delayed Diagnosis of Hirschsprung Disease Impact Post-operative and Functional Outcomes? A Multi-Center Review From the Pediatric Colorectal and Pelvic Learning Consortium
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Sarah Ullrich, Kelly Austin, Jeffrey R Avansino, Andrea Badillo, Casey M Calkins, Rachel C Crady, Megan M Durham, Megan K Fuller, Ankur Rana, Ron W Reeder, Rebecca M Rentea, Michael D Rollins, Payam Saadai, K Elizabeth Speck, Richard J Wood
video1:09 · Oct 2024
The rule of thumb is if there's a segment less than 30 centimeters of inadequate HAPCs, they are not super aggressive about it; over 30 centimeters is definitely more of a red flag Colorectal Quiz: Episode 42 - HD Constipation · 11:01
The Colorectal Quiz Episode 8: Motility Disorders Part 1
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Motility disorder is a team sport - that's why today, we're talking to our colleagues in Pediatric Gastroenterology, Dr. Anil Darbari from Children's National Hospital and Dr. Kahleb Graham from Cincinnati Children's Hospital. Special guest
podcast14:04 · Mar 2021
Colorectal Quiz Episode 16: Bowel Management in Spinal Patients - Need for a Urologist Part 2
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Bowel management can be difficult on its own but for patients with spinal disorders, it can be exponentially more complex. Today, Dr. Levitt and Dr. Frischer discuss bowel management for this subset of patients and they brought some friends
podcast14:18 · Jul 2021
Colorectal Quiz: Episode 42 - HD Constipation
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In this episode of the Colorectal Quiz, Drs. Mark Levitt, Jason Frischer, and Chris Gayer discuss a complex case of persistent constipation in a patient with a history of Hirschsprung’s disease. Despite a successful pull-through surgery in
podcast14:48 · Dec 2024
Expert statements from the recordings in this collection.
Does Delayed Diagnosis of Hirschsprung Disease Impact Post-operative and Functional Outcomes? A Multi-Center Review From the Pediatric Colorectal and Pelvic Learning Consortium
The Pediatric Colorectal and Pelvic Learning Consortium conducted a multi-center retrospective review from 2017 to 2023 examining the relationship between delayed diagnosis of Hirschsprung disease and postoperative/functional outcomes.
Alex Halpern0:12
The study included 679 patients with Hirschsprung disease from 14 different sites.
Alex Halpern0:23
Increased age at diagnosis was associated with a greater likelihood of undergoing fecal diversion after initial pull-through procedure.
Alex Halpern0:29
Increased age at diagnosis was associated with an increased risk of constipation or incontinence requiring intervention postoperatively.
Alex Halpern0:39
No association was found between age at diagnosis and 30-day complication rate after initial pull-through.
Alex Halpern0:49
No association was found between age at diagnosis and need for pull-through revision.
Alex Halpern0:49
Delayed diagnosis of Hirschsprung disease affects certain postoperative and functional outcomes in patients.
Alex Halpern0:58
The Colorectal Quiz Episode 8: Motility Disorders Part 1
Failure of medical management is defined as appropriate treatment with no appropriate response
Kahleb Graham2:51
Patients who cannot take treatment (e.g., kids with autism or other cognitive problems) are considered to have failed medical management
Kahleb Graham3:04
Patients with persistent symptoms or pain with treatment, or failure to grow, are considered to have failed medical management
Kahleb Graham3:04
Failure of retrograde enemas is considered failure of medical management
Kahleb Graham3:21
Reliance on rectal therapy or retrograde enemas with continued soiling causing significant effect on functioning is considered failure of medical management
Anil Darbari3:35
General pediatricians typically prescribe osmotic laxatives (MiraLax, lactulose) and stimulant laxatives (Senna, bisacodyl), but there are other medications GI specialists use that pediatricians are not accustomed to prescribing
Anil Darbari3:57
Some children stool every day but don't completely evacuate
Anil Darbari4:58
Initial evaluation includes history (triggers, stooling frequency, sensation of complete emptying), physical exam (abdominal distension, palpable stool, rectal exam), and diagnostic imaging (abdominal X-ray, water-soluble contrast enema)
Anil Darbari4:46
In patients with long-standing constipation where appropriate treatments have been tried and failed, the first step is diagnostic studies including contrast enema to assess colonic dilation, redundancy, and ensure normal ratio
Kahleb Graham5:27
Water-soluble contrast (not barium) is used for contrast enemas because it helps empty the colon and acts as a cleanout for patients starting new medical therapy
Jason Frischer8:06
Contrast studies are not great predictors of how patients will respond to medical or surgical management; normal-looking colons may not respond while abnormal-appearing colons may respond well
Jason Frischer7:12
The rectoanal inhibitory reflex (RAIR) is the response where the internal anal sphincter relaxes when the rectum becomes distended with stool
Anorectal manometry uses a catheter with sensors measuring pressure and a balloon to assess anal sphincter function and its relationship to the rectum
Anil Darbari9:35
High pressures on anorectal manometry may suggest underlying inability to relax, causing a functional obstruction
Anil Darbari10:00
Patients with Hirschsprung disease have an absent rectoanal inhibitory reflex (RAIR)
Anil Darbari10:09
Anorectal manometry provides information about defecation dynamics by having patients bear down, squeeze, and attempt to defecate, comparing sensation to defecate with internal anal sphincter response
Anil Darbari10:19
Doctor Levitt states he doesn't know how he survived without anorectal manometry testing
In the past, surgeons did not understand the major role the sphincter played in many patients
Colonic motility assessment is critical because in the past, colons or sigmoid colons were resected based on appearance, but patients had motility disorders and did not need resection
Marc Levitt7:36
Many dilated colons will respond to treatment
Marc Levitt7:54
Anorectal manometry is critical for determining whether a patient needs surgery or resection, as patients with motility disorders do not need surgery
Colorectal Quiz Episode 16: Bowel Management in Spinal Patients - Need for a Urologist Part 2
When a 7 cm appendix is shared between urology and colorectal surgery, the urologist typically takes 6.25 cm leaving only 0.75 cm for colorectal use
Jason Frischer1:17
Urologists typically take a 70/30 split when sharing the appendix