Recurrent Respiratory Tract Infections and Pneumonia in a 4‑Year‑Old Girl with Unrecognized Hypoganglionosis Successfully Treated with Transanal Endosurgical Modified Anorectal Myomectomy

Abstract We report a 4‑year‑old girl with recurrent respiratory tract infections and multiple episodes of pneumonia. Despite repeated hospital admissions, the underlying cause remained elusive until severe fecal retention was identified as a contributing factor. Further evaluation revealed previously unrecognized hypoganglionosis. Imaging demonstrated massive fecal loading with diaphragmatic elevation. Rectal biopsies confirmed reduced ganglion cell density consistent with hypoganglionosis. The patient underwent transanal endosurgical modified anorectal myomectomy. Postoperatively, she experienced complete resolution of constipation, improved respiratory mechanics, and cessation of recurrent infections on long term follow up.