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This is the story of an unfortunate 14-year-old boy who presented a week before Christmas in 2014. JGWH was diagnosed with cyclical neutropenia since the age of 2 years old. He is closely monitored by the paediatrician. He had had occasional minor infections with good response to oral antibiotics. In 2009, he was admitted to the paediatric intensive care unit (PICU) for 3 weeks, with neutropenic enterocolitis and responded to broad-spectrum antibiotics. He remained well after that with no septicaemic episodes. On 18 December 2014, he presented with neutropenic septic shock, confirmed by computed tomography (CT) scan with enterocolitis and deteriorated rapidly. He underwent urgent laparotomy, had resection of gangrenous bowel with stoma formation. His postoperative course was extremely "stormy", required multiple inotropes support, intra-aortic balloon pump, haemodialysis and elective amputations of his 4 limbs, to keep him alive. He had prolonged recuperation and was discharged home after 143 days of hospitalisation. Though this boy has a life-crippling event that has transformed his life forever, he survived and is currently doing well, both academically and socially in Australia, with strong family support. This family has gone through this extremely difficult period with strong belief and trust in the medical health care teams and the emotional and psychological support provided were of utmost importance, both for the parents and the child. This case illustrates that with strong will and determination of the child, consolidated by strong family support, JGWH is destined to live his life to the fullest. JGWH may be physically disabled, but he is determined to succeed in his life. The stoma formed may not be as crippling, after all! A cohesive, supportive and dedicated multidisciplinary team management plays an important role to achieve the best outcome for this child. As clinicians, we may not be able to save all lives but we should not take away the hope of a child to live on and hope of the family for the child to live on! [ABSTRACT FROM AUTHOR]

Constipation in children is a common problem. However, its management is anchored mainly by the use of laxatives, without in-depth understanding of its pathophysiology. A proper and appropriate bowel management plan can used judiciously, can identify organic causes and in certain conditions, surgery may be necessary. This presentation illustrates my limited experiences in treating Malaysian children with chronic constipation. In 2013, a new laxative (Movicol), was introduced to treat children with chronic constipation, at University Malaya Medical Centre (UMMC). Movicol was found effective in overcoming the symptoms of constipation in most children. Abdominal radiograph (AXR) is commonly performed to assess children with constipation. However, information gathered limited. With the introduction of gastrointestinal transit study, better understanding of the pathophysiology of constipation has enabled clinicians to stratify the management strategies. In addition, this study also allows the assessment of respond to treatment. This study is currently at research stage at UMMC. We aimed to be the first centre to perform and offer this study for children in South East Asia. Additional study like anorectal manometry has been used in the assessement of anorectal function in children with constipation. It has diagnostic value and can be used to evaluate outcome after surgery in condition like Hirschsprung disease. UMMC is the only centre performing this investigation for Malaysian children. Neuromodulation (in the form of transcutaneous electrical stimulation) was reported to be useful and effective in the treatment of children with intractable chronic constipation. It is non-invasive, and treatment can be performed at home. This can be considered after gastrointestinal transit study assessment before embarking on surgery. Antegrade continence enema (ACE, in the form of appendicostomy) was performed in selected cases of chronic constipation, not responded to laxatives, and has improved quality of life. This procedure is being offered to children who failed to respond to standard medical treatments. In conclusion, the management of children with chronic constipation is very challenging but with better understanding of the gastrointestinal physiology, the management plan can be more focused and targeted. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 13-year-old girl with gastric outlet obstruction and symptomatic anemia. Topics discussed include identification of trichobezoar extending beyond the stomach through endoscopy, trichobezoar extending from the greater curvature of the stomach identified through laparotomy performed with gastrotomy and role of detecting trichotillomania and trichophagia in prevent hairy problem.

Background: Childhood constipation is a common problem with substantial health, economic and emotional burdens. Existing therapeutic options, mainly pharmacological, are not consistently effective, and some are associated with adverse effects after prolonged use. Transcutaneous electrical stimulation (TES), a non-pharmacological approach, is postulated to facilitate bowel movement by modulating the nerves of the large bowel via the application of electrical current transmitted through the abdominal wall., Objectives: Our main objective was to evaluate the effectiveness and safety of TES when employed to improve bowel function and constipation-related symptoms in children with constipation., Search Methods: We searched MEDLINE (PubMed) (1950 to July 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 7, 2015), EMBASE (1980 to July 2015), the Cochrane IBD Group Specialized Register, trial registries and conference proceedings to identify applicable studies ., Selection Criteria: Randomized controlled trials that assessed any type of TES, administered at home or in a clinical setting, compared to no treatment, a sham TES, other forms of nerve stimulation or any other pharmaceutical or non-pharmaceutical measures used to treat constipation in children were considered for inclusion., Data Collection and Analysis: Two authors independently assessed studies for inclusion, extracted data and assessed risk of bias of the included studies. We calculated the risk ratio (RR) and corresponding 95% confidence interval (CI) for categorical outcomes data and the mean difference (MD) and corresponding 95% CI for continuous outcomes., Main Results: One study from Australia including 46 children aged 8 to 18 years was eligible for inclusion. There were multiple reports identified, including one unpublished report, that focused on different outcomes of the same study. The study had unclear risk of selection bias, high risks of performance, detection and attrition biases, and low risks of reporting biases.There were no significant differences between TES and the sham control group for the following outcomes: i).number of children with > 3 complete spontaneous bowel movements (CSBM) per week (RR 1.07, 95% CI 0.74 to 1.53, one study, 42 participants) (Quality of evidence: very low, due to high risk of bias and serious imprecision ), ii). number of children with improved colonic transit assessed radiologically (RR 5.00, 95% CI 0.79 to 31.63; one study, 21 participants) (Quality of evidence: very low, due to high risk of bias, serious imprecision and indirectness of the outcome). However, mean colonic transit rate, measured as the position of the geometric centre of the radioactive substance ingested along the intestinal tract, was significantly higher in children who received TES compared to sham (MD 1.05, 95% CI 0.36 to 1.74; one study, 30 participants) (Quality of evidence: very low, due to high risk of bias , serious imprecision and indirectness of the outcome). There was no significant difference between the two groups in the number of children with improved soiling-related symptoms (RR 2.08, 95% CI 0.86 to 5.00; one study, 25 participants) (Quality of evidence: very low, due to high risk of bias and serious imprecision). There was no significant difference in the number of children with improved quality of life (QoL) (RR 4.00, 95% CI 0.56 to 28.40; one study, 16 participants) (Quality of evidence: very low, due to high risk of bias issues and serious imprecision ). There were also no significant differences in in self-perceived (MD 5.00, 95% CI -1.21 to 11.21) or parent-perceived QoL (MD -0.20, 95% CI -7.57 to 7.17, one study, 33 participants for both outcomes) (Quality of evidence for both outcomes: very low, due to high risk of bias and serious imprecision). No adverse effects were reported in the included study., Authors' Conclusions: The results for the outcomes assessed in this review are uncertain. Thus no firm conclusions regarding the efficacy and safety of TES in children with chronic constipation can be drawn. Further randomized controlled trials assessing TES for the management of childhood constipation should be conducted. Future trials should include clear documentation of methodologies, especially measures to evaluate the effectiveness of blinding, and incorporate patient-important outcomes such as the number of patients with improved CSBM, improved clinical symptoms and quality of life.