Severe Chronic Constipation and Fecaloma in a Patient With Partial Agenesis of the Corpus Callosum: A Case Report.

Abstract

Symptoms of functional constipation are associated with dysregulation of the brain-gut axis (BGA). BGA stands as a framework that accounts for the bidirectional interaction between the central nervous system (CNS), autonomic nervous system (ANS), and the enteric nervous system (ENS). Considering these interactions, the brain (CNS) becomes central to bowel movement/defecation. Consequently, it becomes evident why conditions of the CNS or impacts on the CNS could lead to functional constipation. This case report highlights the intricate relationship between the CNS and GI motility via the BGA. The clinical presentation of partial agenesis of the corpus callosum and refractory fecaloma demonstrates an association between structural neurological deficits and impaired visceral sensory processing, though further studies/investigation are needed to establish a causal link (direct) to the patient's disrupted ability or physiological urge to defecate.  Acute management, such as manual evacuation, can be necessary in severe chronic constipation with fecaloma to prevent life-threatening stercoral perforation. Additionally, long-term management of neurogenic constipation should evolve beyond a standard approach. Individualized management strategies could be considered, which may involve transitioning from an urge-based to a time-based defecation routine, alongside adjuncts like prokinetic agents (e.g., prucalopride) and regular abdominal massage.