Abstract
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.
Résumé
Le traitement chirurgical classique de la constipation sévère idiopathique est la colectomie totale avec anastomose iléorectale mais un tiers des patients ont secondairement une diarrhée importante et 10% constipés. Les études utilisant des marqueurs isotopiques ou radioopaques permettent de préciser la topographie du ralentissement du transit colique. Compte tenu de ces travaux et du fait que le rectum est également anormal chez ces patients, nous avons réalisé une hémicolectomie gauche avec excision rectale chez deux patients ayant un ralentissement colique gauche prouvé. Après deux et trois ans de suivi, ces patients ont un transit normal évalué sur les donnés radiologiques et manométriques. La résection colique segmentaire, basée sur des études physiologiques, peuvent offrir une meilleure amélioration symptômatique au prix d'effets secondaires moindres chez des patient sélectionnés.
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References
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Kamm, M.A., van der Sijp, J.R.M., Hawley, P.R. et al. Left hemicolectomy with rectal excision for severe idiopathic constipation. Int J Colorect Dis 6, 49–51 (1991). https://doi.org/10.1007/BF00703962
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DOI: https://doi.org/10.1007/BF00703962