A Case of Severe Constipation Due to Elongated Sigmoid Colon After Correction of Anocutaneous Fistula, Which Was Successfully Treated by Sigmoidectomy

Abstract

A boy born after 41 weeks of gestation weighing 2,990 g with anocutaneous fistula underwent anoplasty on day 0. During the operation, the urethra and fistula could not be separated sufficiently, resulting in the anus forming anteriorly. To improve the postoperative constipation due to the malposition of the anus, anterior sagittal anorectoplasty (ASARP) was performed at the age of 3 years, and the anus was reformed through the center of the external anal sphincter. Despite those operations, however, he did not achieve sufficient defecation. At that time, plain X-ray findings showed an elongated sigmoid colon and megarectum. We considered the peristaltic disorders in the elongated and dilated colon as the cause of the severe constipation, and we performed sigmoidectomy with tapering of the megarectum at the age of 5 years. The postoperative course was uneventful, and he was discharged on the 12th postoperative day. During the three-year period after the operation, he defecated almost daily, resulting in a marked improvement of his quality of life (QOL). Resection of the elongated sigmoid colon and megarectum might be very effective in patients with severe constipation and an elongated colon, and in whom other causes were ruled out.