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CASE REPORT
Year : 2017  |  Volume : 50  |  Issue : 1  |  Page : 40-43

Intractable constipation in an adult with megarectosigmoid following repair of low-type anorectal malformation


1 Department of Surgery, Division of Pediatric Surgery, Mackay Memorial Hospital, Taipei, Taiwan
2 Department of Pediatric Surgery, Changhua Christian Hospital, Changhua, New Taipei City, Taiwan
3 Department of Surgery, Division of Pediatric Surgery, Mackay Memorial Hospital, Taipei; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
4 Department of Surgery, Division of Colorectal Surgery, Mackay Memorial Hospital, Taipei, Taiwan

Correspondence Address:
Chin-Hung Wei
No. 92, Section 2, Zhongshan North Road, Zhongshan District, Taipei City 10449
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/fjs.fjs_4_17

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A 55-year-old male patient received an anoplasty at infancy for low-type anorectal malformation, and intractable constipation was observed since. The patient presented with colitis at the emergency department. Computed tomography revealed feces with a megarectosigmoid of diameter 18 cm. Hirschsprung disease was suspected on the basis of the imaging findings. Therefore, a rectal biopsy was performed, which indicated the presence of normal ganglion cells. Bowel management was implemented with one large-volume enema to empty the huge rectal pouch daily. The patient was free of constipation and had an improved nutritional status with appropriate weight gain in 3 months. A laparoscopic Swenson pull-through was performed. The hospital course was uneventful. Enemas, loperamide, and water-soluble fibers were required for frequent soiling because of postoperative hypermotile colon. The treatments were weaned off gradually. At the latest follow-up (2 years postoperatively), the patient had regular voluntary bowel movements with complete bowel control.


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