A case of laparoscopic rectopexy for chronic organic constipation due to insufficient fixation of the rectum to the sacrum in a 14-year-old boy

Abstract

Constipation in children can be classified as transient or chronic and as functional or organic. Although most pediatric constipation is functional, organic constipation may be masked by a chronic course. We encountered a case of chronic constipation refractory to treatment with rectal fixation and subsequently diagnosed it as organic constipation. A 14-year-old boy experienced chronic constipation since 8 years of age, and used to attempt defecation for more than 1 h at a time. The symptoms did not improve with conservative treatment such as medications. Rectal contrast revealed that the rectum was flexed ventrally and separated from the sacrum, with dilatation of the intestine on the oral side. He was diagnosed with organic constipation due to insufficient fixation of the rectum to the sacrum, and underwent laparoscopic rectal fixation. Postoperative rectal contrast revealed that the rectum had traveled along the curved surface of the sacrum. Defecation remarkably improved after the surgery. In this case, chronic organic constipation occurred due to insufficient fixation of the rectum to the sacrum, and could be resolved by rectal fixation. We should recognize insufficient fixation of the rectum to the sacrum as one of the causes of chronic constipation, and treat childhood chronic constipation accordingly. ● Chronic organic constipation occurred due to insufficient fixation of the rectum ● Organic constipation improves by correction of anatomical abnormalities ● Insufficient fixation of the rectum can be treated with laparoscopic rectopexy