Internal anal sphincter achalasia primarily occurs in the elderly population.In this study,one male patient aged 85 was admitted to our hospital due to recurrent abdominal distension for 2 years and aggravation for half a month.Abdominal X-ray hinted the signs of intestinal obstruction.Abdominal CT prompted massive dilatation of the colon above the rectum and significant abdominal pneumatosis.It was difficult to insert the anal endoscope due to intolerable pain during the insertion of anal endoscope,and a large quanity of manure water and gas were discharged after the insertion of anal endoscope.He was diagnosed with internal anal sphincter achalasia complicated with intestinal obstruction.The symptoms were alleviated after anal gas discharge by insertion of anal endoscope.Abdominal distension and relevant symptoms recurred after conservative therapy.He was transferred to an upper level hospital for resection of internal sphincter muscle of anus.During postoperative follow-up,the abdominal distension symptoms were mitigated.The patient could normally expel flatus,whereas adjuvant dilator was required for defecation.The diagnosis and treatment of this case prompted that the possibility of internal anal sphincter achalasia should be considered for patients with severe abdominal distension without abdominal pain,loss of flatus and defecation function,palpable anal pain without other pathological changes.%肛门内括约肌失弛缓症以老年人群多见.该文报道了1例85岁男性患者,因反复腹胀2年、加重半个月入院,其腹部X线立位片示肠梗阻.腹部CT提示直肠以上结肠重度扩张,腹部明显积气,肛门镜进镜困难,进镜时患者肛门疼痛难忍,进镜后有大量粪水及气体排出.诊断为肛门内括约肌失弛缓症合并肠梗阻,给予肛门镜排气后腹胀减轻,但症状反复,经内科保守治疗仍然反复腹胀,转至上级医院行肛门内括约肌切除术.随访示患者术后腹胀症状较前减轻,可正常排气,但仍需辅助扩张肛门方可排便.该例的诊治提示,对于腹胀明显而无腹痛、肛门停止排气排便、肛门触诊疼痛而无其他病变患者,要考虑肛门内括约肌失弛缓症的可能.
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