Hábitos defecatorios en niños y adolescentes con mielomeningocele. Resultados de una gran serie incorporados en forma prospectiva

Abstract

Introduction. Myelomeningocele (MMC) is an embryologic neural tube defect. Aim. To determine defecatory habits in MMC patients older and younger than 4 years old according to medullary level and factors affecting catharsis. Patient and methods. Descriptive study of prospective cohort by multidisciplinary team at Posadas Hospital, from March 2003 to March 2017. Inclusion criteria: MMC catered. Exclusion criteria: colostomizated. Results. n = 301. Female: 54%. Age: 1 month to 17 years. Median age: 3 years. GI: 178 patients ≤ 4 years. GII: 123 patients > 4 years. In GI: 82% normal defecation vs. 15% in GII; GI 18% constipation; GII 11% constipation, 79% incontinence. According medullary level: high (thoracic and high lumbar), low (middle lumbar, low lumbar and sacral). Constipation in GI: High 24% and in Low 14% (p = 0.13). GII incontinence in 86% High and in 73% Low (p = 0.06). 37% of walkers without aid, 23% of the children using valves and only 12% of wheelchair bound patients were continent (p = 0.01). Normal school: 30% continent; and 6% who continent attended special school (p = 0.001). Conclusions. 1) More frequent evacuation abnormalities after age of sphincteric control. 2) In ≤ 4 years old, constipation wasn´t related to medullary level; ≥ 4 years old patients defecatory trouble was directly. proportional to medullary level. 3) Special school pupils and wheelchair bound patients > 4 years experienced incontinence degree significantly higher. 4) No difference in defecatory trouble with or without urinary Catheterization. 5) More incontinence in > 4 with ventriculoperitoneal shunt. 6) Functional encopresis must be considered in association with organic factors in this patients.

Differences in rectoanal inhibitory reflex duration between patients with refractory functional constipation and myelomeningocele

“…They also have decreased mobility and often lack adequate bathroom facilities; in addition, their parents -and sometimes physicianshave little information. 9 The bibliography includes little information about the characteristics of RAIR and there are no studies on validated values in terms of RAIR duration. 10,11 Knowing the role of the ENS and the ANS in the innervation of the IAS, which is still controversial at present, may significantly contribute to establishing new strategies and therapeutic approaches in the management of patients with chronic constipation and incontinence.…”

Diferencias en la duración del reflejo rectoanal inhibitorio en pacientes con constipación funcional refractaria y mielomeningocele

“…Además, estos pacientes presentan disminución de su movilidad, suelen tener falta de sanitarios adecuados y se suma la poca información de los padres y a veces de los médicos. 9 Hay poca información en la literatura sobre las características del RRAI y no existen trabajos sobre valores validados en cuanto a la duración. 10,11 Conocer el rol del SNE y del SNA en la inervación del esfínter anal interno, que aún hoy es controvertida, podría contribuir en forma significativa para determinar nuevas estrategias y enfoques terapéuticos en el tratamiento de pacientes con constipación crónica e incontinencia.…”