TY - JOUR
T1 - Severe postoperative chronic constipation related to anorectal malformation managed with osteopathic manipulative treatment
AU - Vismara, Luca
AU - Cozzolino, Vincenzo
AU - Pradotto, Luca Guglielmo
AU - Gentile, Riccardo
AU - Tarantino, Andrea Gianmaria
N1 - Funding Information:
the Universita di Torino PhD Program in Experimental Medicine and Therapy
Publisher Copyright:
© 2020 The Author(s). Published by S. Karger AG, Basel.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020
Y1 - 2020
N2 - Constipation is frequent amongst infants who have undergone surgery for anorectal malformation (ARM). Faecal retention, due to a dysfunctional enteric reflex of defaecation, can cause abdominal cramps, pseudoincontinence and, in the worst cases, megacolon. Prokinetic protocols are used to stimulate at least 1 bowel movement per day, including laxatives, enema, stools softeners and dietary schedules. While osteopathic manipulative treatment is adopted in adults for functional constipation, it has not been described for infants. Herein, we report the case of an infant undergoing anorectoplasty for a low ARM who was referred to the osteopath 2 years after the onset of severe constipation associated with pseudoincontinence and abdominal cramps and was refractory to the prokinetic protocol. In a child with a good ARM prognosis, autonomous daily bowel movements should be achieved. In this child, the imbalanced tension of the pelvic floor and immaturity of the parasympathetic plexus led to a functional alteration of the defaecation reflex. After adjunction of osteopathic manipulative treatment (OMT) to the therapeutic panel, the constipation showed gradual remission, with acquisition of autonomous defaecation 4 months after the therapy began. This suggests the importance of investigating the efficacy of OMT inclusion in the postsurgical prokinetic protocols for ARM patients with a good prognosis.
AB - Constipation is frequent amongst infants who have undergone surgery for anorectal malformation (ARM). Faecal retention, due to a dysfunctional enteric reflex of defaecation, can cause abdominal cramps, pseudoincontinence and, in the worst cases, megacolon. Prokinetic protocols are used to stimulate at least 1 bowel movement per day, including laxatives, enema, stools softeners and dietary schedules. While osteopathic manipulative treatment is adopted in adults for functional constipation, it has not been described for infants. Herein, we report the case of an infant undergoing anorectoplasty for a low ARM who was referred to the osteopath 2 years after the onset of severe constipation associated with pseudoincontinence and abdominal cramps and was refractory to the prokinetic protocol. In a child with a good ARM prognosis, autonomous daily bowel movements should be achieved. In this child, the imbalanced tension of the pelvic floor and immaturity of the parasympathetic plexus led to a functional alteration of the defaecation reflex. After adjunction of osteopathic manipulative treatment (OMT) to the therapeutic panel, the constipation showed gradual remission, with acquisition of autonomous defaecation 4 months after the therapy began. This suggests the importance of investigating the efficacy of OMT inclusion in the postsurgical prokinetic protocols for ARM patients with a good prognosis.
KW - Autonomic nervous system
KW - Constipation
KW - Fascia
KW - Low anorectal malformation
KW - Osteopathic medicine
KW - Paediatric osteopathy
KW - Prokinetic program
KW - Pseudoincontinence
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U2 - 10.1159/000506937
DO - 10.1159/000506937
M3 - Review article
AN - SCOPUS:85084657986
VL - 14
SP - 220
EP - 225
JO - Case Reports in Gastroenterology
JF - Case Reports in Gastroenterology
SN - 1662-0631
IS - 1
ER -