Vismara Luca, Cozzolino Vincenzo, Pradotto Luca Guglielmo, Gentile Riccardo, Tarantino Andrea Gianmaria
Department of Neurosciences, University of Turin, Turin, Italy.
Division of Neurology and Neurorehabilitation - IRCCS Istituto Auxologico Italiano, Piancavallo-Verbania, Italy.
Case Rep Gastroenterol. 2020 Apr 27;14(1):220-225. doi: 10.1159/000506937. eCollection 2020 Jan-Apr.
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.
便秘在接受过肛门直肠畸形（ARM）手术的婴儿中很常见。由于排便的肠道反射功能失调导致的粪便潴留，可引起腹部绞痛、假性失禁，在最严重的情况下，还会导致巨结肠。促动力方案用于刺激每天至少排便一次，包括使用泻药、灌肠、大便软化剂和饮食计划。虽然整骨手法治疗在成人功能性便秘中已被采用，但在婴儿中尚未见相关报道。在此，我们报告一例低位ARM行肛门成形术的婴儿病例，该婴儿在出现与假性失禁和腹部绞痛相关的严重便秘且对促动力方案无效后2年，被转诊至整骨医生处。对于ARM预后良好的儿童，应实现自主每日排便。在该患儿中，盆底张力失衡和副交感神经丛不成熟导致排便反射功能改变。在治疗方案中加入整骨手法治疗（OMT）后，便秘逐渐缓解，治疗开始4个月后实现了自主排便。这表明研究将OMT纳入预后良好的ARM患者术后促动力方案的疗效具有重要意义。
