Andreas Martin Fette
University of Pecs, Germany
Title: Vicious circle: Constipation, overflow-incontinence & megabowel. Report of 2 complex cases
Biography
Biography: Andreas Martin Fette
Abstract
Approximately 12% of patients with bowel emptying disorders under 16 years of age shows signs of mega bowel development. In addition, 25% adolescents and young adults with chronic constipation have already developed a megacolon. Thus, any bowel emptying disorder with signs of mega bowel will constitute a key indication for early and complete diagnostics to give these patients the opportunity to have a healthy large bowel in adulthood. However, among others, the development of a mega bowel is always an alarming sign in front of the immanent (irreversible) bowel wall injury. We would like to report on two Arab children, who have been presented with the main complaints overflow-incontinence and megasigma/rectum. In front of the language barrier, cultural issues and limited technical equipment taking history, clinical examination and compliance have been difficult. After exclusion of the key differential diagnosis elongated sigma and Hirschsprung’s disease, medical textbooks have been revisited for the exact definition of terms in regard to our potential final diagnoses “dolichosigma”, “megarectum”, “rectal inertia syndrome” and “(overflow-) incontinence”, respectively to create an individual treatment plan tailored for each of our patients. Both kids underwent elective surgery. Intraoperative, a massively enlarged bowel segment has been found, resected and sent for histopathology. The children’s postsurgical course have been uneventful, both kids have been reporting continence afterwards. In conclusion, the psychological strain of all children and families involved seems to be the same among all cultures. Pathophysiology is known to be manifold, too. All diagnostic steps and the treatment algorithm are standardized, however, at least for us, some questions remain unanswered.