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Background Severe fecal incontinence (FI) is common in patients both with and without anorectal malformations. Whether a formal bowel management program (BMP) has significant effects on FI, psychosocial development of the child, and caregiver stress is poorly understood. We hypothesize that BMP participation results in long-term clinical and quality of life (QOL) improvements for patients and caregivers. Methods Using a prospective cohort study over three years, 342 children (age 3–12 years) and caregivers were followed for one year after attending a week-long BMP, during which a regimen was tailored to promote daily stool evacuation.FI QOL was measured with the validated Cincinnati Fecal Incontinence Scale (CINCY-FIS), evaluating multiple subscales, including parental stress. Scores were obtained at multiple timepoints following BMP (baseline, 2 weeks, 3 months, 1 year). Results Within 2 weeks, BMP participation significantly improved FI with increased frequency of daily daytime voluntary bowel movements (20%–70%, p< 0.001) and decreased daily daytime and nighttimeinvoluntary bowel movements (60%–20%, p< 0.001; 30%–10%, p< 0.05). Marked improvements in CINCY-FIS were observed across multiple QOL subscales, with the greatest in parental stress, and sustained through one year. Conclusions BMP results in significant and sustained improvement in FI and QOL for patients and caregivers.
Irene Isabel P. Lim; Christopher C. Cushing; Todd Jenkins; Misty Troutt; Margaret H. Zeller; Monir Hossain; Beth Rymeski; Michael Helmrath; Jason S. Frischer. Prospective quality of life outcomes in pediatric fecal incontinence following bowel management. Journal of Pediatric Surgery 2021, 56, 1459 -1464.
AMA StyleIrene Isabel P. Lim, Christopher C. Cushing, Todd Jenkins, Misty Troutt, Margaret H. Zeller, Monir Hossain, Beth Rymeski, Michael Helmrath, Jason S. Frischer. Prospective quality of life outcomes in pediatric fecal incontinence following bowel management. Journal of Pediatric Surgery. 2021; 56 (8):1459-1464.
Chicago/Turabian StyleIrene Isabel P. Lim; Christopher C. Cushing; Todd Jenkins; Misty Troutt; Margaret H. Zeller; Monir Hossain; Beth Rymeski; Michael Helmrath; Jason S. Frischer. 2021. "Prospective quality of life outcomes in pediatric fecal incontinence following bowel management." Journal of Pediatric Surgery 56, no. 8: 1459-1464.
Background : The cumulative incidence and predictors of future diagnosis of Crohn's disease (CD) following presentation with perianal symptoms, such as anorectal abscess, fistula or fissure, is unknown. Methods : A 5-year retrospective review of children presenting with perianal symptoms without prior CD diagnosis was performed. Institutional cumulative incidence of CD was calculated to determine the risk of CD presenting with perianal symptoms. Results : 1,140 children presented for evaluation of an anorectal abscess (n=232), fistula (n=49), or fissure (n=859). Thirty-five were later diagnosed with CD, resulting in an incidence of 3%. Prognostic indicators of future CD diagnosis included increased age per every additional year (RR 1.19, 95% CI: 1.14-1.25, p < 0.001), male sex (RR 2.12, 95% CI 1.07-4.22, p = 0.024), or perianal fistula (RR 4.67, 95% CI 2.26-9.67, p=0.022). Among those diagnosed with CD, 57% experienced and had a documented history of a CD-associated symptom prior to perianal symptom onset. Absence of symptoms resulted in delayed diagnosis (43 vs 3 days, p < 0.02). Conclusion : Of children presenting with a perianal symptom, three percent will eventually be diagnosed with CD. At highest risk (35%) were males aged 10 years or older with a perianal fistula; which should prompt expeditious workup.
Gillian R. Goddard; Irene Isabel P. Lim; Yu-Chia Cheng; Cristine S. Velazco; Todd Jenkins; Nelson G. Rosen; Meera Kotagal; Aaron P. Garrison; Richard Falcone; Beth Rymeski; Jason S. Frischer. A child presents with perianal symptoms - how often is this Crohn's disease? Journal of Pediatric Surgery 2020, 56, 1618 -1622.
AMA StyleGillian R. Goddard, Irene Isabel P. Lim, Yu-Chia Cheng, Cristine S. Velazco, Todd Jenkins, Nelson G. Rosen, Meera Kotagal, Aaron P. Garrison, Richard Falcone, Beth Rymeski, Jason S. Frischer. A child presents with perianal symptoms - how often is this Crohn's disease? Journal of Pediatric Surgery. 2020; 56 (9):1618-1622.
Chicago/Turabian StyleGillian R. Goddard; Irene Isabel P. Lim; Yu-Chia Cheng; Cristine S. Velazco; Todd Jenkins; Nelson G. Rosen; Meera Kotagal; Aaron P. Garrison; Richard Falcone; Beth Rymeski; Jason S. Frischer. 2020. "A child presents with perianal symptoms - how often is this Crohn's disease?" Journal of Pediatric Surgery 56, no. 9: 1618-1622.
We report a unique case of congenital absence of small bowel with associated anorectal malformation and duodenal atresia. Currently, there is no report of a similar case in a live infant in the literature. On initial exploration, the patient was thought to have colonic atresia with an anorectal malformation, and an ostomy proximal to the atretic segment was created. However, postoperative imaging revealed that the stoma was a duodenostomy. The patient subsequently underwent duodenostomy takedown and colostomy creation. He has been doing well and will undergo posterior sagittal anorectoplasty in the future.
Irene Isabel P. Lim; Beth A. Rymeski. Congenital absence of small bowel with anorectal malformation. Journal of Pediatric Surgery Case Reports 2020, 60, 101558 .
AMA StyleIrene Isabel P. Lim, Beth A. Rymeski. Congenital absence of small bowel with anorectal malformation. Journal of Pediatric Surgery Case Reports. 2020; 60 ():101558.
Chicago/Turabian StyleIrene Isabel P. Lim; Beth A. Rymeski. 2020. "Congenital absence of small bowel with anorectal malformation." Journal of Pediatric Surgery Case Reports 60, no. : 101558.
The most common primary malignant liver tumor of childhood, hepatoblastoma has increased in incidence over the last 30 years, but little is still known about its pathogenesis. Discoveries in molecular biology provide clues but have yet to define targeted therapies. Disease-free survival varies according to stage, but is greater than 90% in favorable risk populations, in part due to improvements in chemotherapeutic regimens, surgical resection, and earlier referral to liver transplant centers. This article aims to highlight the principles of disease that guide current treatment algorithms. Surgical treatment, especially orthotopic liver transplantation, will also be emphasized in the context of the current Children’s Oncology Group international study of pediatric liver cancer (AHEP-1531).
Irene Lim; Alexander Bondoc; James Geller; Gregory Tiao. Hepatoblastoma—The Evolution of Biology, Surgery, and Transplantation. Children 2018, 6, 1 .
AMA StyleIrene Lim, Alexander Bondoc, James Geller, Gregory Tiao. Hepatoblastoma—The Evolution of Biology, Surgery, and Transplantation. Children. 2018; 6 (1):1.
Chicago/Turabian StyleIrene Lim; Alexander Bondoc; James Geller; Gregory Tiao. 2018. "Hepatoblastoma—The Evolution of Biology, Surgery, and Transplantation." Children 6, no. 1: 1.