Dumping syndrome and constipation associated with vadar syndrome

[Gigi*5]

Searching for any information with dietary options, nutritional concerns and medications to assist with constipation without suffering explosive bouts of diarrhea, weakness, low blood sugars and extreme low body weight for a 23 month old child.  Have the usual abdominal bloating, pain, vomiting and lethargic symptoms with dehydration.  Have tried prune juice, water, brown sugar diluted in water and tummy drops (laxative) given through g-tube to no avail.  Running out of options but no answers with research or medical doctors available that can provide answers.  Surely there is somewhere that we can go for answers or other medications or clinics that specialize in these areas.  The child also has a growth hormone deficiency and has injections on a daily basis.  Too many complications.  Please tell me you can offer us some information.  Thank you.

[Kevin Pho, MD]

Constipation is common among children, accounting for an estimated 3 to 5 percent of all visits to pediatricians. Complaints range from infrequent bowel evacuation; hard, small feces; difficult or painful evacuation of large-diameter stools, and encopresis (voluntary or involuntary evacuation of feces into the underwear).

Here are a list of tests to consider for diagnosis of the cause:

* Urinalysis and urine culture should be considered in children with a history of rectosigmoid impaction, especially in association with encopresis. Fecal impaction may predispose to urinary tract infections due to the mechanical effects of the distended rectum compressing on the bladder.

* A complete blood count can identify patients with anemia such as may be seen in celiac disease, which may uncommonly be associated with constipation.

* Serum levels of thyroxine and thyroid stimulating hormone should be obtained if hypothyroidism is a consideration.

* A serum calcium and electrolytes should be obtained if the patient is at risk for electrolyte disturbances.

* A lead level may be obtained to investigate potential ingestion.

* A plain abdominal film can be helpful to document retained stool when the physical examination is equivocal.

* An unprepped barium enema is useful in investigating structural causes of constipation and in assessing whether there is an aganglionic segment of bowel (such as in Hirschsprung disease).

* Magnetic resonance imaging of the lumbosacral spine can reveal internal problems such as tumors or tethered cord.

* Anorectal manometry can be useful in the evaluation of suspected Hirschsprung disease.

* Colonic transit studies (using ingested markers) can help distinguish motility disorders from outlet obstruction.

You may want to discuss these options with your physician or gastroenterologist.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

Bibliography:
Ferry et al.  Constipation in children: Etiology and diagnosis.  UptoDate, 2004.

[yoshi]

have they checked his thyroid gland??