ABSTRACT
A 13-year-old male presents with a 7-year history of intractable constipation and encopresis and has had an extensive evaluation. His workup consisted of a contrast enema, a rectal biopsy, and colonic and anorectal manometries. His colonic manometry (CMAN) was normal with high-amplitude propagating contractions (HAPC) and his anorectal manometry (AMAN) was also unremarkable with normal resting pressure, push test, and intact recto-anal inhibitory reflex (RAIR). The rectal biopsy was also normal with ganglion cells present while the contrast enema demonstrated moderately dilated rectosigmoid colon. He has previously participated in a bowel management program, first with an oral laxative regimen with minimal success followed by a regimen of saline and glycerin enemas. The rectal enema regimen was minimally successful due to noncompliance and parents reported that they were traumatic making this option not feasible. He now presents for consideration for possible operative management of his condition. He is continent of urine and has no underlying urinary dysfunction or renal disease. Physical examination revealed an abdomen that was mildly distended but soft, and a normal perianal exam.
