A Case of Chronic Idiopathic Constipation in Which Emergency Surgery Was Required Owing to Defecation Difficulty

Abstract

We report an extremely rare case of a patient who developed shock symptoms caused by fecal impaction due to chronic constipation, who was successfully treated by emergency surgery. The patient was a 14-year-old boy who was referred to the emergency room of a regional hospital owing to vomiting, tachycardia, and hypotension due to increased abdominal distension. The patient had experienced constipation since he was a child, and had sometimes undergone enema treatment and disimpaction at a local clinic. It was judged that the patient had developed abdominal compartment syndrome due to fecal impaction, and he underwent disimpaction under general anesthesia. However, it had no effect. Therefore, we performed emergent laparotomy, removed the feces after making a sigmoid incision, and created a sigmoid colostomy. Considering the possibility of Hirchsprung’s disease, we obtained a biopsy specimen from the rectal mucosa and performed anorectal manometry. However, the results were negative. Thereafter, the rectal pelvic ratio, rectal sensory threshold, and maximum tolerated capacity were periodically measured by abdominal X-ray and enema examination, and an improving trend was observed. The colostomy was closed 21 months after the first surgery after confirming that the megacolon was shrinking. At the time of this writing, three years have passed since the stoma was closed and the patient’s bowel movements have been excellent with occasional use of only oral laxatives.