Exclusion therapy for terminal reservoir syndrome in children with repaired anorectal malformations.
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.
Chen
C C
CC
Department of Surgery, College of Medicine, National Taiwan University, Taipei, R.O.C.
D001003:Anal Canal / Q000601:surgery; D001006:Anus, Imperforate / Q000601:surgery*; D002648:Child; D003248:Constipation / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012007:Rectum / Q000601:surgery; D012086:Reoperation