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Congenital Segmental Dilatation of the Rectosigmoid Colon: A Forgotten Cause of Constipation (Abstract)

Ahmed H. Al-Salem

Department of Peiatric Surgery, Maternity and Children Hopsital, Dammam, Saudi Arabia

 

Abstract

Purpose: To review our experience and discuss the diagnosis and pathogenesis of congenital segmental dilatation (CSD) of the rectosigmoid colon.

Patients and Methods: We studied retrospectively the patients with the diagnosis of CSD of the rectosigmoid colon who were treated in our hospital from 2002 to 2006.

Results: Four patients, all males were found. Their age ranged from 1.3 years to 7 years (mean 3.9 years). All presented with constipation and abdominal distension. The duration of symptoms was variable ranging from as early as immediately after birth to several years prior to presentation. Before surgery, all received several modalities of conservative treatment including dietary manipulation, laxatives, suppositories and enemas with only partial and temporary benefit. All had barium enema which was diagnostic and a preoperative rectal biopsy which showed ganglion cells. One had a temporary colostomy followed by Duhamel’s pull through while the remaining 3 had one stage Duhamel’s pull through after thorough bowel preparation. Two had in addition an anterior reduction of the remaining segment of the rectum. Histology of the resected segment showed normal colon with chronic inflammation and fibrotic changes in some of them as well as normal ganglion cells. Postoperatively, all 4 are doing well, passing once to three times stools per day with no medication and no more abdominal distension.

Conclusions: CSD of the recto sigmoid colon, although a very rare condition, it should be considered in the differential diagnosis of infants and children with constipation and abdominal distension. Barium enema should form part of their investigation and in severe cases, surgical excision is curative.

 

Key words: segmental dilation of intestines, constipation

 

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