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


COD: 525-528 Categorie: ,

Salvatore Franco, Gaspare Foresta, Vittorio Lombardo, Giorgio Giannone

Ann. Ital. Chir., 2007; 78: 525-527

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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.