Caring for children with colorectal disease in the context of limited resources

The management of patients with colorectal disease in the pediatric population is challenging. Such management is all the more challenging when facing the constraints imposed by an environment with limited clinical resources. Three types of colorectal problems are highlighted in this article: anorec...

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Bibliographic Details
Published in:Seminars in pediatric surgery 2010-05, Vol.19 (2), p.118-127
Main Authors: Poenaru, Dan, MD, MHPE, FRCSC, FACS, FCS-ECSA, Borgstein, Eric, MD, FRCS, FCS, Numanoglu, Alp, MBChB, FCS(SA), Azzie, Georges, MD, FRCSC
Format: Article
Language:English
Subjects:
Acquired rectovaginal fistula
Africa
Anorectal malformation
Anus, Imperforate - diagnosis
Anus, Imperforate - surgery
Child, Preschool
Clinical Competence
Colostomy - economics
Colostomy - methods
Cost of Illness
Digestive System Abnormalities - diagnosis
Digestive System Abnormalities - economics
Digestive System Abnormalities - surgery
Digestive System Surgical Procedures - economics
Digestive System Surgical Procedures - methods
Female
Health Resources
Hirschsprung Disease - diagnosis
Hirschsprung Disease - surgery
Hirschsprung's disease
HIV Infections - complications
Humans
Infant, Newborn
Low-income countries
Male
Middle-income countries
Pediatrics
Rectal Fistula - diagnosis
Rectal Fistula - surgery
Surgery
Time Factors
Vaginal Fistula - diagnosis
Vaginal Fistula - surgery
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Description
Summary:The management of patients with colorectal disease in the pediatric population is challenging. Such management is all the more challenging when facing the constraints imposed by an environment with limited clinical resources. Three types of colorectal problems are highlighted in this article: anorectal malformations, Hirschsprung's disease, and acquired rectovaginal fistula in the human immunodeficiency virus–positive population. Through the use of illustrative cases, the authors discuss the pitfalls and challenges encountered in the diagnosis, treatment, and appropriate disposition of these patients. The bulk of the experience used to write this article was acquired in low- and middle-income countries in Africa. The authors hope that the lessons learned will help others manage such patients in the context of limited resources, but recognize that challenges will vary from place to place. There is no substitute for local, contextual expertise.
ISSN:1055-8586
1532-9453
DOI:10.1053/j.sempedsurg.2009.11.017