Left hemicolectomy with rectal excision for severe idiopathic constipation.
The standard surgical therapy for severe idiopathic constipation is total colectomy with ileorectal anastomosis, but this results in intractable diarrhoea in a third of the patients and recurrent constipation in another 10%. Studies which employ either radio-isotopes or radio-opaque markers permit the delineation of regional delay in colonic transit. Based on these studies, and evidence that the rectum is also abnormal in these patients, we have performed a left hemicolectomy with rectal excision in 2 patients with proven left colonic delay. After 2 and 3 years of follow-up, both patients have normal frequency, transit studies and anorectal physiology studies. Segmental resection based on physiological studies may offer better relief of symptoms with a lower chance of side effects in selected patients.
Kamm
M A
MA
St. Mark's Hospital, London, UK.
van der Sijp
J R
JR
Hawley
P R
PR
Phillips
R K
RK
Lennard-Jones
J E
JE
D000328:Adult; D003082:Colectomy / Q000379:methods*; D003248:Constipation / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005772:Gastrointestinal Transit / Q000502:physiology; D006801:Humans; D012007:Rectum / Q000601:surgery*; D013997:Time Factors