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© 2018. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Background and Aim

Polyethylene glycol (PEG) is the gold standard for fecal disimpaction in constipation. A regimen of PEG combined with the stimulant laxative sodium picosulphate (SPS) produced fecal disimpaction in chronically constipated children in the community, but it is unknown if it is effective for more severe constipation. To determine the stool output and effect of a combined PEG and SPS regimen on fecaloma in children with severe constipation and impaction.

Methods

Children with symptoms for a duration of ≥2 years, a palpable fecaloma, and enlarged rectum on X‐ray (rectal: pelvic ratio > 0.6) were recruited from a tertiary hospital. Daily diaries recorded laxative dose, stool frequency, volume, and consistency (Bristol stool scale, BSS). Abdominal X‐rays were taken on day 1 and day 8, and stool loading was assessed using the Leech score. Laxative doses were based on the child's age. The dose of PEG with electrolytes taken was 2–8 sachets (14.7 g/sachet) on days 1–2, reducing to 2–6 sachets on day 3. The SPS dose was 15–20 drops on days 2–3.

Results

Eighty‐nine children (4–18 years) produced a large volume of soft stool (median/inter‐quartile‐range: 2.2/1.6–3.1 L) over 7 days. Stool volume on X‐rays decreased significantly in the colon (P < 0.001). Fecalomas resolved in 40 of 89 children, while 49 needed a second high dose. Rectal:pelvic ratios did not change.

Conclusions

A combined high dose of PEG and SPS on days 1 and 2 was effective in removing the fecaloma in half of the children. Administering high doses for a longer period should be tested to provide outpatient disimpaction for severe fecalomas. Rectums remained flaccid after emptying.

Details

Title
Treatment of fecal impaction in children using combined polyethylene glycol and sodium picosulphate
Author
Lamanna, Anthony 1 ; Dughetti, Lauren D 1 ; Julie A Jordan‐Ely 2 ; Dobson, Kyla M 2 ; Dynan, Megan 1 ; Foo, Adeline 1 ; Kooiman, Louise M P 3 ; Murakami, Naomi 4 ; Fiuza, Kaic 5 ; Foroughi, Siavash 6 ; Leal, Marcelo 7 ; Vidmar, Suzanna 8 ; Anthony G Catto‐Smith 9   VIAFID ORCID Logo  ; Hutson, John M 10 ; Southwell, Bridget R 10   VIAFID ORCID Logo 

 Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia 
 Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia 
 Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; University of Groningen, Groningen, The Netherlands 
 Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; RMIT University, Bundoora, Victoria, Australia; Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, Brazil 
 Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; University of South Australia, Adelaide, South Australia, Australia; Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, Brazil 
 Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Systems Biology and Personalised Medicine Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia 
 Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia 
 Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Clinical Epidemiology & Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia 
 Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia; Gastroenterology Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia 
10  Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Urology, Royal Children's Hospital, Melbourne, Victoria, Australia 
Pages
144-151
Section
Original Articles
Publication year
2018
Publication date
Aug 2018
Publisher
John Wiley & Sons, Inc.
e-ISSN
23979070
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2329725453
Copyright
© 2018. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.