WOFAPS 2025 8th World Congress of Pediatric Surgery

Dipo Mas Suyudi, Leecarlo Millano Lumban Gaol, Yuliana Saraswati Kusuma Prabaningrum

Department of Surgery, Pediatric Surgery Division, Tarakan General Hospital, Central Jakarta, Indonesia

Introduction : Intractable constipation refers to persistent constipation that does not respond to standard therapeutic interventions. It is a very common problem in pediatrics, presenting with a wide range of severity and requiring varying levels of treatment. Managing this condition presents significant challenges and may require a combination of pharmacological, non-pharmacological, and surgical strategies. When left unresolved, intractable constipation can severely affect a patient’s quality of life and place a considerable burden on healthcare systems. Therefore, identifying effective and safe treatment options remains a critical priority.

Case Presentation: A 14-year-old girl presented with fecal incontinence due to fecal impaction, which began in August 2024, following a Duhamel pull-through procedure in February 2023. She required disimpaction, laxatives, and enemas, but her symptoms recurred. After initiating rectal irrigations twice a week, she failed to respond to treatment and was unable to defecate independently after several months. Patients who lack the capacity to consistently achieve voluntary bowel movements may require surgical intervention to allow for antegrade enemas, either via the appendix or using a button device. This approach is useful in patients with severe constipation unresponsive to intensive medical management. Permanent stomas are considered an option of last resort.

Conclusion : Physicians vary in their approaches to surgical decision-making for children with treatment-resistant functional constipation. Most surgical procedures are indicated after medical management has been deemed unsuccessful; however, there is no universally accepted definition of treatment failure. Laparoscopic MACE (Malone Antegrade Continence Enema) is a safe, practical, and effective minimally invasive option for managing severe constipation and fecal incontinence in children. This technique offers potential benefits in terms of cosmetic outcomes and overall surgical success.