Megavejiga obstructiva en pediatría: el estreñimiento como causa oculta de daño renal. Reporte de un caso
Obstructive megabladder in pediatrics: constipation as a hidden cause of kidney damage. A case report
Resumen
RESUMEN La disfunción vesicointestinal es una entidad frecuente y subdiagnosticada en pediatría. La coexistencia de estreñimiento crónico e incontinencia urinaria puede favorecer presión intravesical elevada, reflujo vesicoureteral, infecciones urinarias recurrentes y daño renal progresivo. Caso clínico: Paciente preescolar femenina de 5 años, procedente de zona rural andina, con estreñimiento crónico e incontinencia urinaria persistente y múltiples episodios de impactación fecal sin seguimiento especializado. Ingresó por fractura distal de radio y cúbito izquierdos; durante la evaluación se evidenció distensión abdominal con masa palpable infraumbilical. Los estudios demostraron impactación fecal, megavejiga, ureterohidronefrosis bilateral, reflujo vesicoureteral izquierdo grado V y derecho grado IV, residuo postmiccional, megacolon difuso y dolicocolon sigmoideo. Presentó infecciones urinarias recurrentes por Klebsiella spp. La gammagrafía renal con 99mTc-DMSA mostró función diferencial de 94% en el riñón derecho y 6% en el izquierdo. Se realizó nefrectomía izquierda y cirugía reconstructiva urológica, con evolución posterior a enfermedad renal crónica. Conclusiones: La disfunción vesicointestinal persistente puede representar una condición de alto riesgo nefrourológico. El reconocimiento precoz del estreñimiento y la incontinencia urinaria es fundamental para prevenir daño renal irreversible.
ABSTRACT Bladder-bowel dysfunction is a common and underdiagnosed condition in pediatrics. The coexistence of chronic constipation and urinary incontinence can contribute to elevated intravesical pressure, vesicoureteral reflux, recurrent urinary tract infections, and progressive kidney damage. Case Report: A 5-year-old female preschooler from a rural Andean area presented with chronic constipation, persistent urinary incontinence, and multiple episodes of fecal impaction without specialized follow-up. She was admitted for a distal fracture of the left radius and ulna; during the evaluation, abdominal distension with a palpable infraumbilical mass was noted. Imaging studies revealed fecal impaction, megabladder, bilateral ureterohydronephrosis, grade V left and grade IV right vesicoureteral reflux, post-void residual urine, diffuse megacolon, and sigmoid dolichocolon. He presented with recurrent urinary tract infections caused by Klebsiella spp. A renal scintigraphy with 99mTc-DMSA showed differential function of 94% in the right kidney and 6% in the left. A left nephrectomy and urological reconstructive surgery were performed, with subsequent progression to chronic kidney disease. Conclusions: Persistent vesicointestinal dysfunction may represent a high-risk nephro-urological condition. Early recognition of constipation and urinary incontinence is essential to prevent irreversible kidney damage.
Recibido: 30-07-2026.
Aceptado: 04-09-2026.
Publicado: 25-09-2026
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Depósito Legal Electrónico: ME2016000090
ISSN Electrónico: 2610-797X
DOI: https://doi.org/10.53766/GICOS
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