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

TL;DR

An 8-year-old girl with severe constipation and colonic motility issues was successfully treated through a series of surgical steps.

Contribution

This case demonstrates a stepwise surgical approach for managing intractable constipation due to diffuse colonic dysmotility.

Findings

A stepwise surgical approach led to successful management of constipation in a patient with diffuse colonic dysmotility.

An upfront subtotal resection may benefit patients with diffuse colonic dysmotility if rectal emptying ability is confirmed.

The patient maintained daily bowel movements with fiber and loperamide six months after completion colectomy.

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.

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