Megarectum: a rare complication of imperforate anus repair and its surgical correction by endorectal pullthrough

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Colorectal Surgery

Background:

• Constipation and incontinence are common pediatric complaints.
• Atonia and dilation of the rectum and rectosigmoid can cause severe functional bowel obstruction.
• Diagnostic imaging like barium enema is crucial for identifying these conditions.

Observation:

• Nine pediatric patients (3 months to 15 years) presented with severe constipation and/or increasing incontinence.
• All patients exhibited a significantly dilated and atonic rectum and rectosigmoid on barium enema studies.
• This presentation suggests a potential link between rectal atonia and severe functional bowel issues in children.

Findings:

• Six out of nine patients achieved good to excellent outcomes following an endorectal pull-through procedure for resection of the abnormal bowel segment.
• One patient was successfully treated with a Swenson procedure.
• Surgical intervention appears to be an effective treatment for this condition.

Implications:

• The endorectal pull-through procedure offers a promising surgical solution for pediatric patients with severe constipation and incontinence due to rectal atonia.
• Early diagnosis and surgical management can significantly improve quality of life for affected children.
• Further research could explore the underlying causes of rectal atonia in this pediatric population.