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[Anteposition of the anus. A cause of constipation in children]
Insights
Severe constipation in some patients may stem from an anteriorly displaced anus, an anatomical anomaly. A simple surgical correction offers favorable outcomes for this condition.
Area of Science:
- Gastroenterology
- Pediatric Surgery
Context:
- Idiopathic severe constipation can be linked to anatomical abnormalities.
- Anterior displacement of the anus creates a rectal "cul-de-sac", impeding fecal passage.
Purpose:
- To describe the anatomical anomaly of anteriorly displaced anus causing severe constipation.
- To present a simple surgical treatment and its favorable results in 11 cases.
Summary:
- Anteriorly displaced anus causes severe constipation by forming a "cul-de-sac" that obstructs stool.
- Diagnosis involves physical examination, barium enema, and manometry to exclude Hirschsprung disease.
- Surgical correction of the displaced anus yielded positive outcomes in the reported cases.
Impact:
- Highlights a treatable cause of severe, refractory constipation.
- Offers a surgical solution for anatomical defecation disorders.
- Improves patient quality of life by resolving chronic constipation issues.
Abstract:
Certain forms of severe constipation, unresponsive to medical treatment and classified as "idiopathic", have been thought to be anatomical anomalies due to anterior-displacement of the anus. The difficulty in defecation varies with the anal anomaly: this may range from passing of feces every 3-4 days to sub-occlusion episodes due to obstruction of the rectum from phecaloma and with sign of malnutrition, anemia and hypotrophy. Anatomically the anomaly is characterized by an anterior positioning of the anus which deviates the terminal part of the rectum in a horizontal plane creating a "cul-de-sac" which arrests normal fecal advancement. Fecal stasis in the rectal ampulla leads to an increase in the distensibility of the rectum with loss of the normal stimulus to defecate and contractile activity. Diagnosis is made by physical examination, barium enema (which reveals the rectal "cul-de-sac" and the distension of the colon) and ano-rectal manometry to rule out Hirschsprung diseases. The authors report their experience with 11 cases of anterior displacement of the anus, presenting a simple surgical treatment and the favorable results.