Postoperative megarectum in an adult patient with imperforate anus and rectourethral fistula.

Yoshifumi Nakayama,Takayuki Torigoe,Naohiro Fujimoto,Masaki Akiyama,Noritaka Minagawa,Toshihito Uehara

doi:10.1155/2015/613926

Yoshifumi Nakayama, Takayuki Torigoe + Show 4 more

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https://doi.org/10.1155/2015/613926

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Abstract

This report presents a surgical case of postoperative megarectum in an adult patient with imperforate anus/anorectal malformations. A 71-year-old Japanese male presented with a mass in the lower abdomen which was 15 × 12 × 8 cm in diameter, edema in the right lower extremity, and frequent urination. He had undergone sigmoid loop colostomy for an imperforate anus as a newborn infant. At 28 years of age, the sigmoid loop colostomy was changed to sigmoid divided colostomy in the left lower abdomen. Computed tomography revealed a large cystic mass in the lower abdomen. Retrograde urethrography indicated a rectourethral fistula and megarectum with stones. A small laparotomy incision was created in the right lower abdomen, and the wall of the megarectum was identified. Approximately 2,300 mL of gray muddy fluid was identified and drained. A mucous fistula of the upper rectum was created in the right lower abdomen. This is an extremely rare case of postoperative megarectum in an adult patient with an imperforate anus and rectourethral fistula.

Highlights

Imperforate anus/anorectal malformations occur in approximately 1 in 5000 births [1, 2]
Imperforate anus/anorectal malformations are classified into three main groups high, intermediate, and low according to the relationship between the end of the bowel and pelvic floor [3]
A retrograde urethrography indicated a rectourethral fistula between the prostate urethra and lower rectum, and the distal end of the rectum was located beyond the pelvic floor (Figure 2(a))

Summary

Introduction

Imperforate anus/anorectal malformations occur in approximately 1 in 5000 births [1, 2]. This rare anomaly is usually detected and repaired by pediatric surgeons during the neonatal period or early infancy. In patients with a high imperforate anus, the bowel ends above the pelvic floor, typically with a fistula to the prostatic urethra in males or the posterior vaginal fornix in females. In patients with an intermediate imperforate anus, the bowel traverses the pelvic floor with its crucial puborectalis sling but fails to migrate back to the normal anal site. This report presents an extremely rare surgical case of postoperative megarectum in an adult patient with an imperforate anus

Case Report

Discussion

Conflict of Interests