35 Transition requirements for patients with anorectal malformations
Rachel Harwood1,2, Felicity Arthur1, Sarah Almond1,2, Simon Kenny1,2, Graham Lamont1, Colin Baillie1
1Alder Hey in the Park, Liverpool, United Kingdom. 2University of Liverpool, Liverpool, United Kingdom

Abstract

Children with anorectal malformations (ARM) often have constipation or some degree of faecal incontinence. Both have a significant impact on psychological and physical well-being. An effective bowel management strategy (BMS) should be established and reliably maintained in adolescence to ensure social continence before transition. Adolescents need a care package that supports their BMS in the adult sector. The burden of delivery of such support is poorly described and is under current scrutiny by commissioners.

Aim: To define BMS employed for children born with anorectal malformation as they approach transition.

Methods: Data were collected for 95 children born with ARM between January 2001 and December 2006 (current ages 11-17 years). Their ARM is described according to contemporaneous classification (Wingspread). The primary outcome measure was requirement for BMS, including colostomy, antegrade colonic enema (ACE), retrograde bowel irrigation (Peristeen), enema, or suppository, but excluding oral laxatives at their most recent clinic visit.

Results: Table 1

Conclusions: Over half of all children with ARM (54%) including 27% of those with a low ARM require a BMS to achieve social continence. Approximately 5 children transition to adult services each year within our region. Recognising and quantifying this need enables commissioning of appropriate service provision in the adult sector.

 

Low, n=62

Intermediate, n=14

High, n=19

Female (%)

28 (45%)

0

6 (32%)

Spine abnormality

14 (23%)

7 (50%)

8 (42%)

Spinal surgery

9 (15%)

6 (43%)

2 (11%)

Followed up elsewhere

19

2

2

Discharged n; age (Median{IQR})

17; (5 years {3-11})

3; (7 years {4-7.5})

 

2; (8.5 years {7-10})

Ongoing follow-up

-BMS required

-Suppositories

-Enemas

-Peristeen

-ACE

-Colostomy

26

7 (27%)

1 (4%)

0

3 (12%)

0

3 (12%)

9

9 (100%)

2 (22%)

0

2 (22%)

3 (33%)

2 (22%)

15

11 (73%)

0

1 (7%)

3 (20%)

3 (33%)

4 (27%)

Table 1

Website
Yes