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CC BY 4.0 · European J Pediatr Surg Rep. 2024; 12(01): e23-e25
DOI: 10.1055/a-2212-0411
Case Report

Colonic Resection in an 8-Year-Old Girl with Intractable Functional Constipation and Diffuse Colonic Dysmotility and Failed Antegrade Flushes

Gabriella Danziger
1   Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
,
Thomas O. Xu 
1   Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
,
Teresa Lynn Russell 
1   Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
,
Laura Tiusaba 
1   Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
,
Jennie Yun
1   Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
,
Marc A. Levitt
1   Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
,
Andrea Badillo
1   Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
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Abstract

Optimal surgical management of patients with intractable constipation and diffuse colonic motility is not well defined. We present a patient with such a history, who ultimately achieved successful surgical management of constipation through a stepwise approach. An 8-year-old female presents with longstanding constipation and diffuse colonic dysmotility demonstrated with colonic manometry. She initially underwent sigmoid resection and cecostomy which failed and required diverting ileostomy. We initially proceeded with an extended resection, colonic derotation (Deloyers procedure), and neo-appendicostomy (neo-Malone) which resulted in successful spontaneous stooling for 1 year. Her constipation recurred and she subsequently underwent completion colectomy with ileorectal anastomosis given that she previously demonstrated ability to stool independently. Six months from surgery the patient continues to stool daily with assistance of fiber and loperamide. This case highlights a stepwise surgical approach to managing constipation due to diffuse colonic dysmotility and demonstrates that diffuse dysmotility may benefit from an upfront subtotal resection; however, it is crucial to assess a patient's ability to empty their rectum prior.

Keywords

functional constipation - idiopathic constipation - antegrade continence enemas - colonic resection - diffuse colonic dysmotility


Publication History

Received: 07 June 2023

Accepted: 21 October 2023

Accepted Manuscript online:
16 November 2023

Article published online:
31 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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