Bowel management for the treatment of pediatric fecal incontinence

Fecal incontinence is a devastating underestimated problem, affecting a large number of individuals all over the world. Most of the available literature relates to the management of adults. The treatments proposed are not uniformly successful and have little application in the pediatric population. This paper presents the experience of 30 years, implementing a bowel management program, for the treatment of fecal incontinence in over 700 pediatric patients, with a success rate of 95%. The main characteristics of the program include the identification of the characteristics of the colon of each patient; finding the specific type of enema that will clean that colon and the radiological monitoring of the process

Presentation and management of epigastric hernias in children

Background/Purpose: Although epigastric hernias are common there are no reports that describe the presentation and treatment of these defects in children. The authors reviewed their experience with these hernias to develop recommendations for their management in this age group. Methods: Medical records were reviewed for all children younger than 18 years who presented for evaluation of an epigastric hernia at our institution over 14 years. Data on presentation operative findings and postoperative results were obtained. Results: Forty children were evaluated for an epigastric hernia representing 4% of all pediatric patients seen for treatment of a hernia. An epigastric hernia was first observed at birth in 12 patients (30%). All children presented with a mass in the epigastrium. The hernia was observed to be either symptomatic (abdominal wall pain or tenderness) or enlarging in 22 patients (55%). Thirty-eight children underwent repair and 2 were lost to follow-up. There was no recurrence or morbidity associated with surgical repair of these defects. Conclusions: Epigastric hernias are common in children and frequently present in infancy. Because most are either symptomatic or enlarging the authors recommend repair of these defects at the time of presentation. Copyright (C) 2000 by W.B. Saunders Company