Failed stapled rectal resection in a constipated patient with rectal aganglionosis.
A rare case of a severely constipated patient with rectal aganglionosis is herein reported. The patient, who had no megacolon/megarectum, underwent a STARR, i.e., stapled transanal rectal resection, for obstructed defecation, but her symptoms were not relieved. She started suffering from severe chronic proctalgia possibly due to peri-retained staples fibrosis. Intestinal transit times were normal and no megarectum/megacolon was found at barium enema. A diverting sigmoidostomy was then carried out, which was complicated by an early parastomal hernia, which affected stoma emptying. She also had a severe diverting proctitis, causing rectal bleeding, and still complained of both proctalgia and tenesmus. A deep rectal biopsy under anesthesia showed no ganglia in the rectum, whereas ganglia were present and normal in the sigmoid at the stoma site. As she refused a Duhamel procedure, an intersphincteric rectal resection and a refashioning of the stoma was scheduled. This case report shows that a complete assessment of the potential causes of constipation should be carried out prior to any surgical procedure.
Lorenzo C Pescatori, Mario Pescatori, Coloproctology Unit, Clinica Parioli, 00100 Rome, Italy.
Lorenzo C
LC
Pescatori
Lorenzo C Pescatori, Mario Pescatori, Coloproctology Unit, Clinica Parioli, 00100 Rome, Italy.
Vincenzo
V
Villanacci
Lorenzo C Pescatori, Mario Pescatori, Coloproctology Unit, Clinica Parioli, 00100 Rome, Italy.
Mario
M
Pescatori
D001464:Barium / Q000737:chemistry; D001706:Biopsy; D003248:Constipation / Q000601:surgery; D003672:Defecation; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004733:Enema; D005260:Female; D005355:Fibrosis; D006547:Hernia / Q000150:complications / Q000473:pathology; D006627:Hirschsprung Disease / Q000601:surgery; D006801:Humans; D008531:Megacolon / Q000601:surgery; D008875:Middle Aged; D012008:Recurrence; D017792:Surgical Stapling / Q000009:adverse effects*
D001464:Barium
Constipation; Obstructed defecation; Parastomal hernia; Rectal agangliosis; Stapled rectal resection