Colonic Resection in an 8-year-old girl with Intractable Functional Constipation and diffuse Colonic Dysmotility and failed antegrade flushes

Abstract

Introduction: Optimal surgical management of patients with intractable constipation and diffuse colonic motility is not well defined. We present a patient with such a history, who ultimately achieved successful surgical management of constipation through a stepwise approach. Case description: An 8-year-old female presents with longstanding constipation and diffuse colonic dysmotility demonstrated with colonic manometry. She initially underwent sigmoid resection and cecostomy which failed and required diverting ileostomy. We initially proceeded with an extended resection, colonic de-rotation (Deloyer’s procedure) and neo-appendicostomy (neo-Malone) which resulted in successful spontaneous stooling for one year. Her constipation recurred and she subsequently underwent completion colectomy with ileorectal anastomosis given that she previously demonstrated ability to stool independently. 6 months from surgery the patient continues to stool daily with assistance of fiber and loperamide. Conclusion: This case highlights a stepwise surgical approach to managing constipation due to diffuse colonic dysmotility and demonstrates that diffuse dysmotility may benefit from an upfront subtotal resection, however it is crucial to assess a patient’s ability to empty their rectum prior.