Saito Koichi, Kinoshita Yoshiaki, Takahashi Yoshiaki, Kobayashi Takashi, Arai Yuhki, Ohyama Toshiyuki, Yokota Naoki
Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, Japan.
Surg Case Rep. 2021 May 6;7(1):112. doi: 10.1186/s40792-021-01197-5.
The antegrade continence enema (ACE) procedure is effective for severe constipation in patients with spina bifida and can improve quality of life (QOL). The Monti-Malone procedure (MM), which is a method of creating an enema tract from the colon, has been reported as an alternative to the ACE procedure when the appendix cannot be used. We report the usefulness of MM as a reconstruction of the antegrade continence enema procedure.
Our patient was a 22-year-old man with congenital spina bifida and hydrocephalus. Ventriculoperitoneal (VP) shunt surgery was performed immediately after birth, and preventative appendectomy was carried out during VP shunt repair when 4 months old. At 5 years of age, the ACE procedure using a balloon-button gastrostomy tube was performed for intractable chronic constipation. Simple management was expected, but after 17 years of age, he experienced increased stool leakage around the gastrostomy tube and his QOL declined due to difficulty in managing the ACE. Therefore, reconstruction of the ACE procedure by MM was performed. After reconstruction, the ACE performed well without any complications. The patient is currently satisfied because management of the ACE is easier than before, and his QOL has markedly improved without stool leakage and dermatitis.
MM is less likely to cause complications and is useful as a reconstruction of the ACE procedure.
顺行性可控灌肠（ACE）手术对脊柱裂患者的严重便秘有效，且可改善生活质量（QOL）。蒙蒂 - 马龙手术（MM）是一种从结肠创建灌肠通道的方法，当无法使用阑尾时，已被报道可作为ACE手术的替代方法。我们报告了MM作为顺行性可控灌肠手术重建方法的有效性。
我们的患者是一名22岁的男性，患有先天性脊柱裂和脑积水。出生后立即进行了脑室腹腔（VP）分流手术，并在4个月大进行VP分流修复时进行了预防性阑尾切除术。5岁时，因顽固性慢性便秘进行了使用球囊按钮胃造瘘管的ACE手术。原本期望管理简单，但17岁后，他在胃造瘘管周围出现粪便渗漏增加，且由于管理ACE困难，其生活质量下降。因此，通过MM对ACE手术进行了重建。重建后，ACE运行良好，无任何并发症。患者目前很满意，因为ACE的管理比以前更容易，且他的生活质量显著提高，没有粪便渗漏和皮炎。
MM引起并发症的可能性较小，作为ACE手术的重建方法很有用。
