Related Experiment Video
Updated: Sep 22, 2026
A Treatment Package without Escape Extinction to Address Food Selectivity
Published on: August 21, 2015
Exclusion therapy for terminal reservoir syndrome in children with repaired anorectal malformations
1Department of Surgery, College of Medicine, National Taiwan University, Taipei, R.O.C.
Insights
Constipation and fecal impaction can occur after imperforate anus repair due to a dilated rectal pouch. Surgical exclusion of this ectatic bowel segment is recommended for improved bowel function and continence.
Area of Science:
- Pediatric Surgery
- Colorectal Surgery
- Pediatric Gastroenterology
Background:
- Imperforate anus repair can lead to functional bowel issues.
- A dilated, ectatic terminal bowel segment is a recognized complication.
- Symptoms include constipation, dyschezia, and encopresis with fecal impaction.
Purpose of the Study:
- To investigate the causes and outcomes of functional bowel obstruction after imperforate anus repair.
- To evaluate the efficacy of surgical exclusion of the ectatic terminal bowel.
Main Methods:
- Retrospective analysis of 12 cases with imperforate anus and subsequent bowel issues.
- Rectal suction biopsy to rule out Hirschsprung's disease (aganglionosis).
- Surgical intervention involving exclusion of the ectatic terminal bowel (excision or pull-through) in nine patients.
Main Results:
- Eight of nine patients who underwent bowel exclusion achieved regular bowel movements and continence within six months.
- Conservative measures and anal revision were largely ineffective.
- Associated pelvic or sacrospinal anomalies were noted in four cases.
Conclusions:
- A dilated, ectatic terminal bowel segment is a significant cause of constipation post-imperforate anus repair.
- Early surgical exclusion of the ectatic bowel offers satisfactory functional outcomes.
- Rectal ectasia may be primary or secondary, depending on the initial anorectal malformation severity.
Abstract:
Constipation, dyschezia and encopresis in association with fecal impaction in a hugely dilated ectatic terminal bowel were noted in 12 cases of imperforate anus after creation of an anorectal canal. The original anorectal malformations were of low anomalies in four cases, intermediate in one, and high in seven. Associated anomaly in the pelvis or sacrospinal area was present in four of the 12 cases, and dilated rectal pouch at birth was found in four of the eight patients examined. The symptom of constipation started invariably within a few months after anoplasty or closure of colostomy. Suction biopsy of the rectum excluded the possibility of aganglionosis. As elaborate conservative measures, including revision of the anteriorly displaced anus, failed to relieve the symptoms, exclusion of the ectatic terminal bowel by either excision or endorectal pull-through was carried out in nine of the 12 cases. The results were satisfactory: eight of the nine patients developed regular bowel movements and were totally continent within six months of surgery. It is suggested that the terminal reservoir is caused by primary rectal ectasia in the low anomalies and by primary or secondary ectasia, or a combination of both, in the high anomalies. Early exclusion of the ectatic terminal bowel is recommended for patients suffering from this syndrome after repair of anorectal malformations.
