Decline in gut motility of cerebral palsy patients after a triggering event: A discussion on invasive versus conservative management.

[OBJECTIVES] Patients with cerebral palsy (CP) often have gastrointestinal dysmotility. An inciting event, such as infection, may lead to progressive decline in bowel motility and episodes of acute pediatric intestinal pseudo-obstruction (PIPO). Surgery can be implemented when medical therapy fails, but it is unclear if it can improve or lengthen the quality of life. Here, we explore this question with a case series.

[METHODS] We performed a retrospective chart review and identified five patients with CP who were hospitalized between January 2017 to January 2024, secondary to a triggering event. They all developed subsequent decline in bowel function.

[RESULTS] We present five gastrostomy tube-dependent patients with CP who had prolonged hospitalizations after a triggering event and an associated decline in intestinal motility. Case 1 is a 7-year-old female with feeding intolerance after a viral infection and a hospital stay of 30 days. She received anal sphincter botulinum toxin injection and returned to baseline. Case 2 is 21-year-old male with aspiration pneumonia who became dependent on total parenteral nutrition (TPN). He died after complications associated with midgut volvulus. Case 3 is an 18-year-old male with feeding intolerance following COVID and required several procedures, a hospital stay of 205 days, and gradual return to baseline. Case 4 is a 15-year-old male with a small bowel obstruction and recurrent volvulus, prolonged hospitalization, and death. Case 5 is a 4-year-old female with frequent PIPO triggered by urinary tract infections.

[CONCLUSION] Patients with CP are susceptible to a decline in bowel function. A balance between prolonging life and improving quality of life should always be considered. TPN in place of surgical interventions might help decrease hospitalizations and surgical morbidity. Surgery is reasonable for mechanical obstruction, but invasive procedures should not be assumed to improve quality of life.