Katherine Cameron, MD, Joshua Tyler, MD, Ramon Brown, MD. Keesler Medical Center
Objective: Fecal incontinence can be a debilitating problem significantly diminishing productivity and quality of life. Sacral neuromodulation has emerged as a first line surgical option treatment in patients with fecal incontinence. Though its efficacy has been rigorously evaluated in adult populations there is scant data available for its use in the pediatric pateints with fecal incontinence. This case study discusses the management of fecal incontinence in a pediatric patient with a history of Hirschsprung’s disease utilizing sacral nerve stimulation.
Methods: Our patient is a 15-year-old female with a history of Hirshsprung’s diagnosed in infancy and treated surgically with coloanal pull through at the age of 1 who presented with complaints of fecal incontinence. The patient was wearing pads daily, noting frequent uncontrolled bowel movements as well as having frequent missed days of school due to these symptoms. Despite maximal medical management and pelvic floor physical therapy the patient continued to have 3-10 episodes of fecal incontinence daily. A CT scan with rectal contrast was used to establish her post-operative anatomy. Anal manometry showed low rest/squeeze pressures, absent resting anal inhibitory reflex, and abnormal sensation. Furthermore, during balloon expulsion testing the patient failed to pass device. The patient was deemed a candidate for Stage 1 testing with sacral nerve neuromodulation. During follow-up, the patient was noted to have resolution of her episodes of fecal incontinence and the second stage was completed. The patient continues to note 100% continence and dramatic improvement in her quality of life.
Conclusion: In this patient with a history of severe fecal incontinence due to Hirschsprung’s disease, sacral neuromodulation has had a significant impact on her quality of life. Post-operatively she continues to have marked improvement in her symptoms with 4-5 bowel movements a day with no recurrence of fecal incontinence. The use of sacral neuromodulation is a promising treatment for fecal incontinence in the pediatric population. Future research investigating the long-term efficacy of this treatment modality in the pediatric population is needed.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88309
Program Number: P207
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster