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.
Keywords
functional constipation - idiopathic constipation - antegrade continence enemas -
colonic resection - diffuse colonic dysmotility
