title: Pelvic widening to alleviate the mechanical component of constipation in a patient with severe caudal regression and extremely narrow pelvis.
abstract: BACKGROUND
  Constipation in children is a commonly encountered problem with a broad variety of causes. Constipation caused by a narrow pelvis has, to our knowledge, not been reported in the human literature.
  
  
  METHODS
  Retrospective review of patient chart, in depth follow-up appointment with the patient and review of literature.
  
  
  RESULTS
  A 15 year old girl with sacral agenesis and significant co-morbidities was referred for consideration of cecostomy tube placement to manage her constipation. Digital rectal exam revealed a very narrow pelvic outlet and CT scan confirmed abnormal configuration of the bony pelvis. Discussions with orthopaedic colleagues concluded that bilateral pelvic osteotomies to widen her pelvis may relieve her constipation. The procedure was uneventful and radiologic follow-up confirmed widening of the pelvic outlet and increased pelvic volume. Her stooling pattern improved postoperatively and she was satisfied with the result on follow up at one year.
  
  
  CONCLUSIONS
  Although previously described only in the veterinary literature, surgical widening of a narrow pelvis can be considered for the management of constipation in the rare patient with appropriate physical and radiologic findings.
authors.affiliation: Division of General and Thoracic Surgery, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. chethan.sathya@gmail.com
authors.forename: Chethan
authors.initials: C
authors.lastname: Sathya
authors.forename: Kjetil
authors.initials: K
authors.lastname: Ertresvaag
authors.forename: James
authors.initials: J
authors.lastname: Wright
authors.forename: Georges
authors.initials: G
authors.lastname: Azzie
mesh_terms: D000015:Abnormalities, Multiple; D000293:Adolescent; D000671:Amputation, Surgical; D002431:Cecostomy; D003248:Constipation / Q000151:congenital / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007668:Kidney / Q000002:abnormalities; D016030:Kidney Transplantation; D007866:Leg / Q000002:abnormalities; D010027:Osteotomy / Q000379:methods*; D010384:Pelvic Bones / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012086:Reoperation; D012447:Sacrum / Q000002:abnormalities