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Corresponding Author

Ismail, Mohamed

Document Type

Case Series

Abstract

Background: Constipation is the most common childhood condition occurring in about 3% of children. Patients who have intractable idiopathic or functional constipation (FC) with pseudo encopresis that is unresponsive to bowel management program with no underlying organic cause constitutes a serious medicosocial problem in the pediatric age group. Objective: Evaluation of effectiveness of sigmoidectomy with partial proctectomy in solving the problem of intractable idiopathic constipation in children with megarectosigmoid. Patient and Methods: This was a Prospective case series study for evaluation of the effect of sigmoid resection with partial proctectomy in improving children with intractable idiopathic constipation with megarectosigmoid. The study was conducted on 20 patients. That was selected from more than 250 of idiopathic constipation children. All patients were operated at the Pediatric Surgery Department, Al-Azhar University Hospitals. The study was of 30 months duration(Feb 2018-July 2020). We used Rome III criteria and Pediatric Incontinence Constipation Score to evaluate constipation and incontinence pre and post operatively. Detailed history taking, clinical examination(including rectal examination) and investigations(including laboratory tests, radiologic examinations, rectal biopsy). Results: The study included 20 patients, 7 females and 13 males. Patients ages ranged from 4-13 years(mean=7.2). Constipation was the main complain in all patients followed by soiling. Sigmoidectomy with partial proctectomy recorded 90% success in improving constipation and consequently soiling; the results of Sigmoidectomy without partial proctectomy was disappointing. Conclusion: Rectosigmoidectomy is the best surgical management for the children suffering from intractable functional constipation with Megarectosigmoid, Partial removal of the rectum is very crucial in improving results.

Keywords

Functional constipation; idiopathic constipation; Megarectosigmoid; sigmoidectomy; Intractable constipation

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