Rare complication after anterior resection of the rectum and colon reconstruction: severe constipation with obstructed defecation. Report of a Case

Abstract

OBJECTIVE: The aim of this manuscript is to verify the impact that some recanalization procedures for intestinal continuity could have in bowel function and quality of life.

STUDY MATERIAL: We describe a clinical case of a rectal cancer patient who underwent anterior resection of the rectum with colo-anal anastomosis, coloplasty and diverting ileostomy.

RESULTS: After the diverting ileostomy closure, suffered of severe bowel function problems. The establishment of a coloplasty caused a syndrome of such severe obstructed defecation to necessitate the reestablishment of a diverting ileostomy.

DISCUSSION: Anterior resection with total mesorectal excision and colo-anal anastomosis is the gold standard surgical treatment of rectal carcinoma. The so called “anterior resection syndrome” is well known after such surgical procedures. The establishment of a reservoir such as the J-pouch and more recently the transverse pouch (coloplasty) are procedures used to improve the quality of life after anterior resection of the rectum.

CONCLUSIONS: The presence of bowel obstruction without mechanical causes makes us consider the coloplasty as its cause with a Hirschprung like mechanism or similar to the “obstructed defecation”. The peristalsis stops at the coloplasty level impeding the progression of feces. The coloplasty or the pouch do not function as a reservoir to accommodate feces, but because they stop the peristalsis.