Suboptimal correction of low anorectal anomalies: a possible cause for intractable constipation in children
Background Constipation is a common problem among patients following the repair of low anorectal anomalies. We present our experience in managing constipation in a group of these patients with reoperation to correct residual anterior anal misplacement.
Patients and methods The study included pediatric patients presenting with significant constipation following the repair of low anorectal anomalies. Patients with evidence of residual anterior anal misplacement (either clinically, by means of MRI, or using electrical muscle stimulation) were offered a reoperation to bring their ani backward to an orthotropic position.
Results Thirteen patients were included in the study between September 2009 and June 2015. Their ages ranged from 1.5 to 10 years. The primary anomaly was rectoperineal fistula in 10 (seven boys and three girls) and rectovestibular in three girls. Two types of reoperations were performed: a posterior anoplasty with posterior sphincterotomy (five cases), and a limited sagittal anorectoplasty (eight cases). Straining at defecation was relieved in all patients. Of the 13 patients, nine were relieved from their constipation (69%) and had regular bowel movements without medications. The remaining four (31%) showed partial improvement.
Conclusion Among patients with low anorectal anomalies, suboptimal correction with residual anterior anal misplacement represents one correctable cause for persistence of constipation.