ASCRS U | Diagnosis and Management of Rectocele 4

Diagnosis and Management of Rectocele 4

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Pelvic Floor
- An 18-year-old woman with a lifelong history of constipation requiring daily enema use presents to your office. Anorectal manometry cannot elicit a rectoanal inhibitory reflex. On contrast enema, the rectum is dilated down to the internal sphincter without a visible transition zone. Full-thickness biopsies taken of the rectum just proximal to the dentate line shows aganglionosis and hypertrophic nerve trunks. The biopsy specimen taken approximately 2 cm above the internal sphincter shows normal ganglion cells. What is the best next step in management?
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