Surgically Correctable Fecal Incontinence Associated with Traumatic Duhamel Operation: A Report of Three Cases

ABSTRACT

We present 3 cases of fecal incontinence associated with traumatic injury during Duhamel procedure. Three male patients suffered from persistent fecal soiling and incontinence for more than 7 years after definitive surgery for Hirschsprung's disease by a pediatric surgeon. They showed grade 4 frequent major soiling, mild patulous anus, and flattening of the anorectal angle due to traumatic injury of the external sphincter and puborectalis muscle on the posterior midline of the anorectal junction. On Parks postanal pelvic floor repair procedures, the incontinent symptoms were abated, anatomic changes were normalized, and postoperative Kirwan classification scales were markedly improved from grade 4 to grade 1. Patients with fecal incontinence after Duhamel operation for Hirschsprung's disease may have a traumatic injury of the anal sphincter. Careful physical and laboratory examinations should be performed for the confirmation of traumatic injury in these patients, and Parks postanal repair could be the treatment of choice for the correction of incontinence.