Department of Surgery, National Hospital Organization, Higashihiroshima Medical Center, Hiroshima, Japan.
Department of Gastrointestinal and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Am J Case Rep. 2021 Sep 11;22:e932764. doi: 10.12659/AJCR.932764.
BACKGROUND Hartmann procedure can be necessary for the treatment of rectal cancer and colonic perforation. The distal diverted intestinal tract is usually disregarded, while the proximal colon is diverted with a stoma. Most of the reported complications related to a diverted intestinal tract following Hartmann procedure include inflammation and intestinal tumors; however, there are only a few reports about postoperative anal complications. Herein, we report a rare case of anal atresia following Hartmann procedure. Anal atresia is generally considered as a congenital malformation; therefore, this was an extremely rare case, as there are no previous reports about anal atresia following Hartmann procedure. CASE REPORT An 84-year-old woman presented to our hospital with a persistent feeling of incomplete evacuation. She had undergone Hartmann procedure for diverticular disease of the sigmoid colon, with perforation, 5 years ago and had no major complications after the surgery. She had no history of anal disorders such as hemorrhoids or anal fissures. On examination, her anus was found to be closed by a thin skin, and computed tomography revealed stool retention in the diverted rectum. The anus was surgically opened to remove the stool, after which the feeling of incomplete evacuation resolved with no subsequent recurrence. CONCLUSIONS This is the first report of anal atresia in a patient following Hartmann procedure. The surgical intervention was effective in resolving the blockage and relieving the patient's feeling of incomplete evacuation.
Hartmann 手术可用于治疗直肠癌和结肠穿孔。远端转流肠段通常被忽略，而近端结肠则通过造口转流。大多数与 Hartmann 手术后转流肠段相关的并发症包括炎症和肠道肿瘤；然而，只有少数关于术后肛门并发症的报道。在此，我们报告一例 Hartmann 手术后罕见的肛门闭锁病例。肛门闭锁通常被认为是一种先天性畸形；因此，这是一个极其罕见的病例，因为之前没有 Hartmann 手术后肛门闭锁的报道。
一名 84 岁女性因持续感觉排便不完全而就诊。她 5 年前因乙状结肠憩室病伴穿孔行 Hartmann 手术，术后无重大并发症。她没有痔疮或肛裂等肛门疾病史。检查时发现肛门被一层薄皮封闭，计算机断层扫描显示转流直肠内有粪便潴留。通过手术切开肛门以清除粪便，此后，排便不完全的感觉得到缓解，且无后续复发。
这是首例 Hartmann 手术后肛门闭锁的报告。手术干预有效解决了梗阻，缓解了患者的排便不完全感。
