Results of anal or low rectal anastomosis and pouch construction for megarectum and megacolon.
Over a 16-year period 34 patients underwent surgery for idiopathic megarectum or megacolon; 18 had megarectum with or without megasigmoid, one megacolon only and 15 megarectum and total megacolon (nine with a previous colectomy). Ten patients underwent low rectal or anal anastomosis without pouch formation (colodistal proctostomy, eight; coloanal anastomosis, two), eight had colonic pouch-anal anastomosis (J pouch) and 14 had an ileal J pouch after restorative proctocolectomy; one underwent subtotal colectomy with ileorectal anastomosis and one loop ileostomy alone. There was one death, from intestinal obstruction 24 months after operation. Twenty-seven of 32 evaluable patients without a stoma became fully continent following resection and sphincter-saving procedures. Three of 18 had a poor result after resection for megarectum because of recurrent constipation. One of 14 patients became incontinent after restorative proctocolectomy for megacolon and megarectum and in a further four persistent abdominal distension and pain was treated by pouch excision.
Stewart
J
J
University Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Kumar
D
D
Keighley
M R
MR
D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D003248:Constipation / Q000209:etiology / Q000601:surgery; D004108:Dilatation, Pathologic; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008531:Megacolon / Q000601:surgery*; D008875:Middle Aged; D016737:Proctocolectomy, Restorative; D011446:Prospective Studies; D012002:Rectal Diseases / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012008:Recurrence