Pediatric Surgery International

, Volume 35, Issue 2, pp 233–237 | Cite as

Transition of care: a growing concern in adult patients born with colorectal anomalies

  • Shannon Acker
  • Alberto Peña
  • Duncan Wilcox
  • Veronica Alaniz
  • Andrea BischoffEmail author
Original Article



Traditionally, the care of children and adults has been arbitrarily separated into pediatric and adult medicine and surgery. Despite progress in pediatric surgical techniques, patients born with congenital anomalies still suffer from significant functional sequelae, which persist into adulthood. We aim to describe some of the most common problems experienced by adult patients with congenital colorectal malformations.


Following IRB approval, we performed a retrospective database review of all adult patients who were treated by our group from 1983 until 2017.


We identified 88 cases. 51 patients had ARM, 18 cloacas, 9 presacral masses, 3 HD, 2 spina bifida and 5 with other diagnoses (3 vaginal anomalies, 1 cloacal exstrophy, 1 obstructed seminal vesical). The specific problems addressed were: complications from previous operations (41), rectal prolapse (25), fecal incontinence (11), gynecologic concerns (12), urologic concerns (6), and recurrent recto urogenital fistula (3). We performed 83 surgical interventions, including 13 rectal prolapse repair, 13 continent appendicostomies, 44 PSARP or redo PSARP, 11 resections of presacral masses, 11 vaginoplasties, 2 examinations under anesthesia, and 2 Mitrofanoff procedures. Five patients were treated medically (bowel management program, obstetric, urologic evaluation).


There is a growing need to better prepare adult providers to assume the care of patients born with congenital colorectal disease as these patients transition to adulthood. A collaboration between specialized pediatric referral centers with adult colorectal surgeons, urologists and gynecologists is a potential pathway for the adequate transition of care.


Transition of care Anorectal malformation Hirschsprung 


  1. 1.
    Pena A, DeVries PA (1982) Posterior sagittal anorectoplasty: important technical considerations and new applications. J Pediatr Surg 17:796–811CrossRefGoogle Scholar
  2. 2.
    Bischoff A, Levitt MA, Pena A (2013) Update on the management of anorectal malformations. Pediatr Surg Int 29(9):899–904CrossRefGoogle Scholar
  3. 3.
    Alam S, Lawal TA, Pena A et al (2011) Acquired posterior urethral diverticulum following surgery for anorectal malformations. J Pediatr Surg 46(6):1231–1235CrossRefGoogle Scholar
  4. 4.
    Levitt MA, Bischoff A, Pena A (2011) Pitfalls and challenges of cloaca repair: hot to reduce the need for reoperations. J Pediatr Surg 46(6):1250–1255CrossRefGoogle Scholar
  5. 5.
    Bischoff A, Levitt MA, Bauer C et al (2009) Treatment of fecal incontinence with a comprehensive bowel management program. J Pediatr Surg 44:1278–1284CrossRefGoogle Scholar
  6. 6.
    Bischoff A, Levitt MA, Peña A (2009) Bowel Management for the treatment of pediatric fecal incontinence. Pediatr Surg Int 25:1027–1042CrossRefGoogle Scholar
  7. 7.
    Bischoff A, Tovilla M (2010) A practical approach to the management of pediatric fecal incontinence. Semin Pediatr Surg 19:154–159CrossRefGoogle Scholar
  8. 8.
    Rangel SJ, Lawal TA, Bischoff A et al (2011) The appendix as a conduit for antegrade continence enemas in patients with anorectal malformations: lessons learned from 163 cases treated over 18 years. J Pediatr Surg 46:1236–1242CrossRefGoogle Scholar
  9. 9.
    Samuk I, Bischoff A, Hall J et al (2016) Anorectal malformation with rectobladder neck fistula: a distinct and challenging malformation. J Pediatr Surg 51:1592–1596CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Shannon Acker
    • 1
  • Alberto Peña
    • 1
  • Duncan Wilcox
    • 2
  • Veronica Alaniz
    • 3
  • Andrea Bischoff
    • 1
    Email author
  1. 1.Department of Pediatric Surgery, International Center for Colorectal and Urogenital Care, Children’s Hospital ColoradoUniversity of ColoradoAuroraUSA
  2. 2.Department of Pediatric Urology, International Center for Colorectal and Urogenital CareChildren’s Hospital ColoradoAuroraUSA
  3. 3.Division of Pediatric and Adolescent Gynecology, International Center for Colorectal and Urogenital CareChildren’s Hospital ColoradoAuroraUSA

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