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

Nakayama Y, Uehara T, Akiyama M, Minagawa N, Torigoe T, Fujimoto N - Case Rep Gastrointest Med (2015)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu 807-8555, Japan ; Department of Gastroenterological and General Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu 808-0024, Japan.

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.

No MeSH data available.


Related in: MedlinePlus

(a) Retrograde urethrography indicated a dilated rectum (black double concentric circles), urinary bladder (black star), and rectourethral fistula between the prostate urethra and lower rectum (black arrow) with stones (black cross). (b) Magnetic resonance imaging (MRI) revealed a megarectum (white double open circles) with stones (white cross).
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fig2: (a) Retrograde urethrography indicated a dilated rectum (black double concentric circles), urinary bladder (black star), and rectourethral fistula between the prostate urethra and lower rectum (black arrow) with stones (black cross). (b) Magnetic resonance imaging (MRI) revealed a megarectum (white double open circles) with stones (white cross).

Mentions: A 71-year-old Japanese male presented with an increasing lower abdominal mass and frequent urination. He had undergone sigmoid loop colostomy for an imperforate anus as a newborn. At 28 years of age, he underwent an operation for which the details are unclear. At that time, the sigmoid loop colostomy was changed to sigmoid divided colostomy in the left lower abdomen. The patient had not used the colostomy pouch before arriving at our hospital. He was referred to the surgical outpatient clinic for a detailed examination and surgical treatment of an increasing lower abdominal mass, edema of the right lower extremity, and frequent urination. Computed tomography (CT) revealed a large cystic mass measuring 15 × 12 × 8 cm in diameter in the lower abdomen (Figures 1(c) and 1(d)). CT performed two years previously at the other hospital showed a smaller cystic mass measuring 11 cm × 8 cm in diameter in the lower abdomen (Figures 1(a) and 1(b)). Retrograde urethrography indicated a rectourethral fistula and megarectum with stones (Figure 2(a)). Moreover, magnetic resonance imaging (MRI) revealed a megarectum with stones (Figure 2(b)).


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

Nakayama Y, Uehara T, Akiyama M, Minagawa N, Torigoe T, Fujimoto N - Case Rep Gastrointest Med (2015)

(a) Retrograde urethrography indicated a dilated rectum (black double concentric circles), urinary bladder (black star), and rectourethral fistula between the prostate urethra and lower rectum (black arrow) with stones (black cross). (b) Magnetic resonance imaging (MRI) revealed a megarectum (white double open circles) with stones (white cross).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4377439&req=5

fig2: (a) Retrograde urethrography indicated a dilated rectum (black double concentric circles), urinary bladder (black star), and rectourethral fistula between the prostate urethra and lower rectum (black arrow) with stones (black cross). (b) Magnetic resonance imaging (MRI) revealed a megarectum (white double open circles) with stones (white cross).
Mentions: A 71-year-old Japanese male presented with an increasing lower abdominal mass and frequent urination. He had undergone sigmoid loop colostomy for an imperforate anus as a newborn. At 28 years of age, he underwent an operation for which the details are unclear. At that time, the sigmoid loop colostomy was changed to sigmoid divided colostomy in the left lower abdomen. The patient had not used the colostomy pouch before arriving at our hospital. He was referred to the surgical outpatient clinic for a detailed examination and surgical treatment of an increasing lower abdominal mass, edema of the right lower extremity, and frequent urination. Computed tomography (CT) revealed a large cystic mass measuring 15 × 12 × 8 cm in diameter in the lower abdomen (Figures 1(c) and 1(d)). CT performed two years previously at the other hospital showed a smaller cystic mass measuring 11 cm × 8 cm in diameter in the lower abdomen (Figures 1(a) and 1(b)). Retrograde urethrography indicated a rectourethral fistula and megarectum with stones (Figure 2(a)). Moreover, magnetic resonance imaging (MRI) revealed a megarectum with stones (Figure 2(b)).

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu 807-8555, Japan ; Department of Gastroenterological and General Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu 808-0024, Japan.

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.

No MeSH data available.


Related in: MedlinePlus