Surgical management of chronic unremitting constipation and fecal incontinence associated with megarectum: A preliminary report

Abstract

Background/Purpose: Functional constipation with associated fecal incontinence responds poorly to medical management once megarectum has developed. The authors describe resecting the dilated rectum and inserting a cecostomy button for antegrade enemas in this difficult condition.

Is there a role for surgery beyond colonic aganglionosis and anorectal malformations in children with intractable constipation?

“…Recently, we have presented data on the beneficial use of more aggressive management of severe refractory constipation in children utilizing antegrade enemas via cecostomy in neurologically normal patients with no known organic cause for their symptoms. 4 In a preliminary report, Lee et al 5 have described 4 children who were neurologically normal and had evidence of an acquired motility disorder of the distal recto-sigmoid colon that benefited from surgical removal of the diseased area and showed normal defecatory dynamics at long-term follow-up. 5 The purpose of this study was to report our experience with surgery in a group of children who had failed medical treatments for severe constipation and had no evidence of colonic aganglionosis or anatomic anorectal defects.…”

Congenital pouch colon associated with anorectal agenesis (pouch colon syndrome)

“…We are of the opinion that the incidence in the West is much higher than the one quoted, as many cases of type IV CPC are being inappropriately labelled as rectal ectasia/megarectum-megasigmoid. The case reports of Cloutier et al [2], Pen˜a et al [3], and several others are a case in point [4][5][6][7][8][9]. Children who continued to suffer from severe constipation and overflow incontinence following previous surgery for low/intermediate anorectal malformations (ARM) were referred to these authors.…”

“…The cases reported in the Western literature also appear to be corresponding to type IV pouch, which is usually associated with low/intermediate ARM. Increased awareness of this entity is essential to avoid postoperative problems of severe constipation in this subgroup of patients with ARM as exemplified in the reported cases [2][3][4][5][6][7][8][9]. Excellent results can be obtained by complete excision of the pouch in all cases of type IV CPC prior to anoplasty.…”

Primary sigmoidectomy and appendicostomy for chronic idiopathic constipation

“…In 2002, Lee et al placed a cecostomy button and performed the resection of the megarectum in four patients with fecal incontinence associated with idiopathic constipation [14]. In 2013 Eradi et al created an appendicostomy and performed a colonic resection in 18 patients with anorectal malformations, spina bifida and sacrococcygeal teratoma [15].…”