Fecal Retention in Children With Cystic Fibrosis

Three older children, ages 7, 11, and 18 years old with cystic fibrosis who developed fecal retention requiring operation are reported. One had an asymptomatic right lower quadrant mass which suggested a cecal tumor both by barium enema and at the time of operation. In this patient, a right colon resection was performed. The other two showed signs of acute intestinal obstruction requiring laparotomy. In one, the retained fecal material was so firm and tenacious that it could not be removed through an enterotomy incision and a bowel resection was performed. Six months later the patient again developed intestinal obstruction due to retained fecal material. At this time, an enterostomy allowed removal of the obstructing feces. In the other patient, the acute obstruction could be relieved by "milking" the inspissated feces through the ileo-cecal valve. A review of the literature reveals that now 19 cases of this entity have been reported. Retained impacted fecal material requiring surgical intervention in older children with cystic fibrosis has been documented. It is important for the pediatrician, roentgenologist, and the surgeon to be aware of this complication. It is probable, although not yet proved, that the regular administration of adequate amounts of pancreatin will be helpful in avoiding the occurrence and recurrence of this condition. The use of a laxative diet, lubricative cathartics, and enemas as necessary is advised.