Danziger Gabriella, Xu Thomas O, Russell Teresa Lynn, Tiusaba Laura, Yun Jennie, Levitt Marc A, Badillo Andrea
Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States.
European J Pediatr Surg Rep. 2024 Jan 31;12(1):e23-e25. doi: 10.1055/a-2212-0411. eCollection 2024 Jan.
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.
对于顽固性便秘和弥漫性结肠动力障碍患者，最佳手术治疗方案尚未明确界定。我们报告了一名有此类病史的患者，该患者最终通过逐步治疗方法成功实现了便秘的手术治疗。一名8岁女性因长期便秘和结肠测压显示弥漫性结肠动力障碍前来就诊。她最初接受了乙状结肠切除术和盲肠造口术，但手术失败，需要进行转流性回肠造口术。我们最初进行了扩大切除术、结肠旋转复位术（德洛耶尔手术）和新阑尾造口术（新马龙手术），术后患者成功自主排便1年。之后便秘复发，鉴于她之前已表现出自主排便能力，随后接受了全结肠切除术及回肠直肠吻合术。术后6个月，患者在纤维和洛哌丁胺的辅助下继续每天排便。该病例突出了针对弥漫性结肠动力障碍导致的便秘的逐步手术治疗方法，并表明弥漫性动力障碍可能受益于前期的次全切除术；然而，术前评估患者直肠排空能力至关重要。
