The Effectiveness of Biofeedback Therapy for Children Patients with Chronic Constipation

PURPOSE: Chronic constipation is not uncommon even in children. Recently biofeedback treatment (BT) is considered as a useful modality in the treatment of various types of constipation. The aim of this study was to evaulate the effectiveness of BT in children with chronic constipation. METHODS: We reviewed 24 cases of childhood constipation (17 boys, 7 girls) who visited the Jinju Hakmoon colorectal surgery clinic and GNUH1 between April, 2001 and September, 2002. Balloon-mediated anorectal manometry system was used for BT. The effects of therapy was assessed by bowel movement, defecation time, fecal soiling and balloon evacuation test in the early course of therapy. The long term follow up survey was done by telephone interview at January 2003 and the effects of therapy was assessed by bowel movement, defecation time, fecal soiling and parents' satisfaction. RESULTS: Patients received the BT for the three times on average, and as the result of the therapy, 20 patients experienced disappearance of symptoms (87%) or at least improvement of symptoms. In terms of manometric values, the mean resting pressure was 113.4 mmHg before the BT, but decreased to 86.3 mmHg after the BT (P=0.0012). Mean pushing pressure dropped to 85.98 mmHg from 130.45 mmHg (P=<0.0001). Mean sensitivity decreased from 55 ml to 35 ml (P=0.0053). Mean compliance decreased from 20.28 H2O/cm to 4.21 H2O/cm (P=0.0015). 13 patients (76%) showed disappearance or improvement of symptoms in the long term follow up. CONCLUSIONS: The Balloon mediated biofeedback therapy is effective in children with chronic constipation. It is safe, easy to administer and also improve symptoms and objective parameters of anorectal function. Balloon mediated biofeedback therapy could be the first-line therapy in child patient with chronic constipation who failed conservative management.

Migrating pancreatic duct stone: a case report / 한국간담췌외과학회지

Most reports describe acute gallstone pancreatitis as a result of common bile duct and pancreatic duct obstruction at the Ampulla of Vater. The pathophysiology leading to the development of pancreatitis includes the common channel theory of obstruction leading to bile reflux, ductal hypertension secondary to pancreatic duct obstruction, and sphincter incompetence with duodenal content reflux.Rarely stones which from common bile duct have been demonstrated by ERCP to lie within the pancreatic duct. We experienced the patient who complained epigastric and RUQ pain. She was 51-year-old and had both intrahepatic duct, common bile duct stones and pancreatic duct stone. Initial amylase and lipase was 112 IU/L, 1925 U/L. We performed Lt. lateral segmentectomy, Roux-en-Y choledochojejunostomy, distal pancreatectomy. So We report this case.