Eftaiha Saleh M, Melich George, Pai Ajit, Marecik Slawomir J, Prasad Leela M, Park John J
Division of Colon and Rectal Surgery, University of Illinois at Chicago, 840 South Wood Street (MC 958), Chicago, IL 60612, USA.
Department of General Surgery, Royal Columbian Hospital, University of British Columbia, New Westminister, BC, Canada.
Int J Surg Case Rep. 2016;24:115-8. doi: 10.1016/j.ijscr.2016.05.018. Epub 2016 May 20.
Bowel dysfunction (fecal incontinence and constipation) presents in over 50% of patients after treatment of congenital anal malformations. Sacral nerve stimulation (SNS) for the treatment of fecal incontinence improves function in the majority of patients. We present a case report of the treatment of bowel dysfunction with sacral nerve stimulation in a patient with a history of an imperforate anus.
A twenty year-old female with a history of imperforate anus at birth, repaired during infancy with anorectoplasty, presented with fecal incontinence and constipation. Since childhood, she had been suffering from intermittent constipation with worsening fecal incontinence in early adulthood. Examination revealed mild anal stenosis and mucosal prolapse. Endoanal ultrasound demonstrated intact internal and external sphincter with low resting and squeeze pressures on anal manometry. Flexible sigmoidoscopy was normal. The patient underwent permanent sacral nerve stimulation with a primary goal of improvement in continence and, secondarily, for the alleviation of intermittent chronic constipation.
At 15 month follow-up, the patient had improvement in fecal incontinence (CCIS of 14 pre-SNS to 1 post-SNS), constipation (CCCS of 28 pre-SNS to 20 post-SNS), and quality of life (FIQOL improved in lifestyle (3.7), coping/behavior (3.4), self perception (3.9), and social embarrassment (4.5).
Sacral nerve stimulation for the treatment of bowel dysfunction in adults secondary to imperforate anus can be performed safely and with good results.
超过50%的先天性肛门畸形患者在接受治疗后会出现肠道功能障碍（大便失禁和便秘）。骶神经刺激（SNS）用于治疗大便失禁，可使大多数患者的功能得到改善。我们报告一例有肛门闭锁病史的患者经骶神经刺激治疗肠道功能障碍的病例。
一名20岁女性，出生时即有肛门闭锁病史，婴儿期行肛门直肠成形术修复，现出现大便失禁和便秘。自童年起，她就间歇性便秘，成年早期大便失禁情况加重。检查发现轻度肛门狭窄和黏膜脱垂。肛管超声显示内外括约肌完整，肛门测压时静息和收缩压力较低。乙状结肠镜检查正常。该患者接受了永久性骶神经刺激，主要目标是改善控便能力，其次是缓解间歇性慢性便秘。
在15个月的随访中，患者的大便失禁情况有所改善（骶神经刺激前CCIS为14，刺激后为1），便秘情况（骶神经刺激前CCCS为28，刺激后为20）以及生活质量（FIQOL在生活方式（3.7）、应对/行为（3.4）、自我认知（3.9）和社交尴尬（4.5）方面均有所改善）。
骶神经刺激用于治疗成人因肛门闭锁继发的肠道功能障碍是安全的，且效果良好。
