Matthew Wynn, MD, Derrick Oaxaca, BS, Harriet Barratt, MD, Caesar Ricci, MD, Ziad Kronfol, MD. TTUHSC EP
Anorectal malformation (ARM) is an embryonic developmental disorder that occurs in 1 in 1500 to 5000 births. ARMs are typically diagnosed and repaired during the neonatal period or early childhood. Posterior sagittal anorectoplasty (PSARP) has been historically considered the gold standard technique for the treatment of ARM due to improved anatomical visualization, and can be used in neonates and pediatric patients, as well as in adults. However, both urinary and fecal function is often compromised after PSARP, even when optimal surgical management is performed. Patients with mild ARM commonly present with constipation for reasons that remain unidentified, but are likely due to malformations in anorectal innervation and rectosigmoid hypomotility. Chronically constipated patients with a history of treated ARM can have continued abnormalities related to intestinal function and colonic caliber, including fecal impaction and overflow encopresis, and often require oral fluid and enema symptomatic treatment. Severe chronic constipation in patients with ARM can also lead to a rare condition called megarectum. We present in this case report a 40 year old male with a past medical history of ARM, who sustained multiple injuries, including a traumatic brain injury, in a high speed motorcycle accident. Abdominal CT on admission incidentally demonstrated a large amount of fecal material impacted within the midsigmoid colon. The colon was focally dilated with subtle peripheral mesenteric inflammatory changes suggestive of stercoral colitis. Due to the inability to remove the mass safely using conventional methods, the mass was removed with the implementation of transanal minimally invasive surgery (TAMIS). To our knowledge, this is the first time that TAMIS has been used to manage an obstructing fecaloma. Further, this case report highlights a clinical scenario that must be suspected in a traumatic brain injury patient with a past medical history of imperforate anus.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91914
Program Number: V266
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop