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Megasigmoid: a source of pseudoincontinence in children with repaired anorectal malformations
1Department of Surgery, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, NY 11042.
Insights
Sigmoid resection effectively treated fecal impaction and incontinence in children with anorectal malformation repairs. This surgery corrected constipation and unexpectedly improved fecal continence in young patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Children with anorectal malformation repairs often experience fecal incontinence and constipation.
- Localized rectosigmoid dilatation can complicate post-surgical management.
- Previous medical treatments for these symptoms have shown limited success.
Purpose of the Study:
- To evaluate the efficacy of sigmoid resection in managing intractable constipation and fecal incontinence in children post-anorectal malformation repair.
- To assess the impact of preserving the rectal ampulla as a reservoir.
Main Methods:
- Surgical resection of the dilated sigmoid colon was performed in three pediatric patients.
- Anastomosis was created between the non-dilated descending colon and the preserved rectal ampulla.
- Patients were monitored for constipation and fecal continence post-operatively.
Main Results:
- All three patients experienced complete resolution of constipation following sigmoid resection.
- Unexpectedly, all patients achieved fecal continence post-surgery.
- Hospitalizations for disimpaction were eliminated.
Conclusions:
- Segmental dilatation of the sigmoid colon is a significant factor in intractable constipation after anorectal malformation repair.
- Sigmoid resection is a viable therapeutic option for managing these complex cases.
- Preserving the rectal ampulla may contribute to improved fecal continence.
Abstract:
Three children with a history of anorectal malformation repairs were referred to the authors for evaluation and management of fecal incontinence. Their ages ranged from 5 to 7 years. On examination, all the children had fecal impaction and localized dilatation of the rectosigmoid colon. Medical treatment was tried but failed to control the symptoms, and the patients frequently had to be hospitalized for disimpaction. To correct this problem, the authors resected the dilated sigmoid colon, anastomosing the nondilated descending colon to the rectal ampulla, which was preserved to serve as a reservoir. Postoperatively, constipation was cured in all patients. In addition the patients became fecally continent postoperatively, which was an unexpected bonus. The authors believe that localized dilatation of the rectosigmoid should always be considered whenever a child is having intractable constipation after repair of an anorectal malformation and that sigmoid resection may be considered as a therapeutic alternative. Segmental dilatation of the sigmoid colon may be a source of fecal pseudoincontinence and, therefore, should be ruled out when the surgeon is evaluating patients with fecal incontinence.