Advances in the pathogenesis, diagnosis and treatment of constipation after operations for anorectal malformations

Abstract

Anorectal malformation is a common congenital digestive tract malformation. With the popularity of posterior sagittalanorectoplasty (PSARP), postoperative constipation has received more and more attention. Clinical manifestations include fecal impaction, megacolon and overflow pseudoincontinence. Constipation is correlated with the type of anorectal malformations. Types of lower fistulas, such as perineal and vestibular fistulas, have a higher incidence of constipation. Procedures of PSARP, including intestinal preservation and operative trauma, also contribute to the occurrence of constipation. Abnormal enteral nervous system and interstitial Cajal cells of preserved intestines may result in constipation. Megacolon caused by constipation results in decreased intestinal motility and then a more severe symptom. For diagnosing constipation, physicians should definite its severity and perform anorectal manometry barium enema, magnetic resonance imaging (MRI), endoanal ultrasonography and even rectal biopsy. Then conservative treatment or operation is selected according to patient condition. Key words: Rectum, abnormalities; Constipation; Surgical procedures, operative