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Failed stapled rectal resection in a constipated patient with rectal aganglionosis.

Abstract
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.
AuthorsLorenzo C Pescatori, Vincenzo Villanacci, Mario Pescatori
JournalWorld journal of gastroenterology (World J Gastroenterol) Vol. 20 Issue 15 Pg. 4462-6 (Apr 21 2014) ISSN: 2219-2840 [Electronic] United States
PMID24764689 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Barium
Topics
  • Barium (chemistry)
  • Biopsy
  • Constipation (surgery)
  • Defecation
  • Digestive System Surgical Procedures (adverse effects)
  • Enema
  • Female
  • Fibrosis
  • Hernia (complications, pathology)
  • Hirschsprung Disease (surgery)
  • Humans
  • Megacolon (surgery)
  • Middle Aged
  • Recurrence
  • Surgical Stapling (adverse effects)

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