Megarectum surgery in the management of constipation

The recent death of a child in Victoria from constipation highlights that constipation is a symptom, not a diagnosis, and that megarectum is both an ill-defined term and a diagnosis. The existence of isolated, non-Hirschsprung Disease rectal dilation is not widely understood as a possible independent pathology, rather than only secondary to constipation from diet issues. The existence of variants of the giant megarectum are too often not factored into the management of children with constipation and imperforate anus. This monograph explores the definitions and differential diagnoses of encopresis, soiling, constipation and megarectum. Then, in turn, the paper considers the investigations considered clinically indicated in children with constipation and megarectum, and goes on to consider when surgery is indicated, and the current outcomes achieved in complex cases of megarectum and constipation.