Recurrence of chagasic megacolon after surgical treatment: clinical, radiological, and functional evaluation.

Chagas disease is an endemic pathology in many regions of Brazil as in most countries of Latin America. The World Health Organization estimates that there are 17 million infected people in Latin America, including 300,000 new cases per year, and 2 to 3 million patients with chronic complications of the disease. Chagasic megacolon is a late complication of this disease and is defined by an increase in diameter and length of the large bowel. Chagasic megacolon is the result of irreversible destruction of the intramural intestinal nervous system that includes the rectum. A progressive and frequently severe constipation associated with complications such as sigmoid volvulus and fecal impaction comprise the clinical picture. Surgical treatment of chagasic megacolon does not cure the disease; the main objectives are the relief of constipation and abolishment of complication risk. 6 Operations for chagasic megacolon today comprise a myriad of techniques that involve different extents of colon resection and anastomotic levels, resulting in variable operative morbidity and recurrence. Partial or total resections of the dilated colon have proven to be inadequate in the management of chagasic megacolon due to the preservation of a dyskinetic rectum, which continues to act as a functional obstacle to bowel emptying. High complication rates associated with abdominoperineal pull-through procedures prompted the development of the Habr-Gama technique at our institution. This operation is an anterior resection of the dilated colon with immediate posterior end-to-side mechanical extraperitoneal colorectal anastomosis. The good results associated with this technique are due to a functional exclusion of the diseased rectum through construction of a large (33-mm diameter, circular, stapled) colorectal anastomosis at the posterior rectal wall, avoiding anterior rectal dissection that can offer risk of autonomic nerve damage. Removal or exclusion of the rectum for patients with chagasic megacolon through an abdominal or abdominoperineal approach is an effective surgical technique. Although postsurgical recurrent constipation may not be observed in some series, it does occur. To the best of our knowledge, there have been no indexed publications about evaluation and treatment of recurrent cases. Therefore, this communication aims to evaluate clinically and radiologically with radiopaque markers the total colonic transit times for patients who presented with symptomatic recurrence of symptoms after elective surgical treatment of chagasic megacolon outside our institution.