Constipation is a clinical condition that is frequently encountered in childhood and its medical treatment fails in 40-50% of the cases. Especially the development of stool incontinence with constipation causes children to be isolated from school and social life. In such cases, if the rectum (the end of the large intestine closest to the anus) is excessively enlarged due to chronic constipation, the probability of responding to medical treatment is very low.
Most of the cases presenting with chronic constipation refer to a pediatric surgeon after taking various medical treatments for a long time. After the physical examination and radiological evaluations, we, as Pediatric Surgeons, try to prevent constipation in our cases by starting with both enemas (enemas) and oral laxatives (orally administered stool softeners). The cases whose complaints do not improve despite intensive drug therapy are re-evaluated with a colon radiography. For the diagnosis of megarectum, constipation should be present in the cases, the rectum should be filled with feces on rectal touch, and the rectal pelvis ratio should be above 0.61 on colon X-ray.
Many surgical treatment options have been described in cases with megarectum. Spanish Pena, one of the most respected surgeons in the world, states that by removing the dilated sigmoid colon, the need for laxatives is reduced by 80%. However, the need for laxative use continues in these cases. It is known that the results are much better in cases where the rectum is excised transanally with the dilated colon. In these patients, a colostomy is performed first in some centers. Thus, the enlarged bowel is rested, then the enlarged bowel is removed up to 4-5 cm from the anoutineal line and combined with the normal diameter descending colon. While the problematic dilated part is removed, the total length of the colon is shortened, thereby reducing the colonic transit time. Then the patient’s colostomy is closed.
In some centers, the enlarged bowel loop can be removed with the help of laparoscopy or laparotomy in a single session without colostomy. In these patients, the operation time can sometimes be long. Patients stay in the hospital for 3-5 days after the operation and are fed with intravenous TPN (total parenteral nutrition) during this period.
While approximately 60% of these operated patients recover from drug addiction, the remaining 40% may need additional medical and surgical treatments in the future.
