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World J Gastroenterol. Apr 21, 2014; 20(15): 4462-4466
Published online Apr 21, 2014. doi: 10.3748/wjg.v20.i15.4462
Published online Apr 21, 2014. doi: 10.3748/wjg.v20.i15.4462
Failed stapled rectal resection in a constipated patient with rectal aganglionosis
Lorenzo C Pescatori, Mario Pescatori, Coloproctology Unit, Clinica Parioli, 00100 Rome, Italy
Vincenzo Villanacci, Patology Unit, Spedali Civili, 25100 Brescia, Italy
Author contributions: Pescatori M and Pescatori LC designed the report; Pescatori M collected the patient’s clinical data and performed the biopsies; Villanacci V performed the histological examination; Pescatori LC, Pescatori M and Villanacci V analyzed the data, wrote and approved the paper.
Correspondence to: Lorenzo C Pescatori, MD, Coloproctology Unit, Parioli Clinic, Via Felice Giordano 8, 00100 Rome, Italy. lorenzo.carlo.pescatori@gmail.com
Telephone: +39-33-81388577 Fax: +39-6-8077290
Received: November 18, 2013
Revised: January 7, 2014
Accepted: February 17, 2014
Published online: April 21, 2014
Revised: January 7, 2014
Accepted: February 17, 2014
Published online: April 21, 2014
Core Tip
Core tip: A patient with persisting constipation following STARR or transanal stapled rectal resection, carried out for rectal internal prolapse, needed a diverting sigmoidostomy. She also had proctalgia due to retained staples. Despite normal manometry and intestinal transit times, a deep rectal biopsy showed marked alterations of the intrinsic plexus, which was the main cause of symptoms. Both morphology and function of the anorectum should be carefully investigated prior to indicate surgery. Obstructed defecation may be considered an “Iceberg syndrome”: the rectal internal prolapse is just the tip of the iceberg, and occult underlying lesions should be properly diagnosed and cured.