Bowel Management Recommendations

A recent “consensus” review on bowel management (G Mosiello et al. JPGN 2017; 64: 343-52) is available as an open access article –Link: Consensus Review of Best Practic of Transanal Irrigation in Children

The use of bowel management tube (or cone) for transanal irrigation has been around since ~1987 (B Shandling et. al. J Ped Surg 1987; 22: 271-3) and generally is considered in children older than 3 years of age with severe problems with defecation (organic and functional).

This particular review has a very good table on troubleshooting (Table 4) and a succinct summary of indications/contraindications (Table 2).

Related blog entries:



What is calretinin?

Calretinin is a ‘calcium-binding protein that is normally expressed in cholinergic nerves.’ (NEJM 2012:366: 361-72)  The absence of calretinin-positive mucosal neurites helps establish a diagnosis of Hirschsprung’s disease, even when suction-biopsy specimens may have previously been considered inadequate.  It is not known why calretinin neurites are absent in Hirschsprung’s disease nor why abnormal acetylcholinesterase-positive neurites are present.

More information on the technical aspects of diagnosing Hirschsprung’s disease and illustrations of these stains is available in this case record.

Additional references:

  • -Mod Pathol 2009; 22: 1379-84. Calretinin in Hirschsprung’s.
  • -Pediatr Dev Pathol 2009; 12: 6-15. Calretinin & acetylcholinesterase in Hirschsprung’s.
  • -JPGN 2011; 53: 75.  Problems post-op.
  • -JPGN 2008; 46:13.  Nice review.
  • -Pediatrics 2002; 109: 914-918.  Review of surgical treatments.