Colectomy for constipation

Q: 82 year old male is admitted to ICU after colectomy as a last resort for debilitating constipation. These patients usually have unbearable abdominal pain? (select one)

A) True

B) False

Answer: B

Subtotal colectomy with ileorectal anastomosis is used as a last resort for debilitating constipation. Contrary to popular belief, severe abdominal pain due to constipation is a contraindication to this treatment. The reason is being as severe abdominal pain points towards pathology other than just constipation. Secondly, these patients tend to have worsening pain after colectomy. There are five criteria to be fulfilled before surgery is considered as a treatment for constipation. 

• Constipation should be unresponsive to all viable medical treatments. 
• Slow colonic transit of the inertia pattern is documented.
• Intestinal pseudoobstruction is ruled out.
• Any pelvic floor dysfunction is ruled out.
• Patient should not have abdominal pain as a presenting symptom.

#surgical-critical-care

#gastroenterology

References:

1. ford SA, Verne GN. Approach to patients with refractory constipation. Curr Gastroenterol Rep 2000; 2:389. 

2. Pikarsky AJ, Singh JJ, Weiss EG, et al. Long-term follow-up of patients undergoing colectomy for colonic inertia. Dis Colon Rectum 2001; 44:179.