Background: Rectal prolapse in the pediatric population is usually a benign and self-limited condition. We present a rare case of severe recurrent rectal prolapse on a 13-year- old patient associated with a redundant sigmoid colon treated with laparoscopic resection.
Case Presentation: A 13-year-old male presented with a five-year history of chronic intermittent rectal prolapse requiring digital reduction on a daily basis. The patient did not have any other co-morbid conditions. Only after manual reduction of the 5-10 cm prolapsed rectum the patient was able to evacuate stool. Preoperative workup, including colonoscopy, contrast enema, anal manometry, defecogram, and sitz marker study, demonstrated an elongated, redundant sigmoid colon with significant prolapse of the sigmoid and rectum through the pelvic floor. With straining, the defecogram also demonstrated the development of a prominent fold in the upper rectum at the level of the peritoneal reflection. Non-operative treatment with stool softeners, Miralax, and bio-feedback failed to provide any improvement. The patient was taken to the operating room for laparoscopic sigmoid colon resection with side-to-side stapled anastomosis. Approximately 13 centimeters sigmoid were resected eliminating the “accordion” effect caused by the redundant sigmoid. A rectopexy was unnecessary as the remaining distal sigmoid and rectum were tethered to the pelvis. The patient was discharged on post-operative day one and his rectal prolapse has completely resolved. He now has normal bowel movement without the use of any laxatives.
Conclusion: We present a rare case of redundant sigmoid colon causing constipation and rectal prolapse in a pediatric patient. This is the first reported pediatric case successfully treated with laparoscopic sigmoid resection.
Program Number: P168