Download PDF
Clin Colon Rectal Surg 2012; 25(01): 020-023
DOI: 10.1055/s-0032-1301755
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Surgical Management of Colonic Inertia

Jacob A. McCoy
1   University of Texas Medical School, Houston, Texas.
,
David E. Beck
2   Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana.
3   Ochsner Clinical School, The University of Queensland School of Medicine, Brisbane, Australia.
› Author Affiliations
Further Information

Publication History

Publication Date:
23 March 2012 (online)

Also available at
   Permissions and Reprints

Abstract

For the select small number of constipated patients that cannot be managed medically, surgical options should be considered. Increases in our knowledge of colorectal physiology and experience have fostered improvements in patient evaluation and surgical management. Currently, patients with refractory colonic inertia are offered total abdominal colectomy and ileorectal anastomosis, often with laparoscopic techniques. With proper patient selection, the results have been excellent for resolving the frequency and quality of bowel movements. However, symptoms such as bloating and abdominal pain, which may be related to irritable bowel syndrome rather than the colonic inertia, may persist.

Keywords

constipation - colectomy - colonic inertia - abdominal pain
 

  • References

  • 1 Beck DE. Colectomy for colonic inertia. Semin Colon Rectal Surg 1992; 3: 115-119
    PubMedGoogle Scholar
  • 2 Beck DE, Jagelman DG, Fazio VW. The surgery of idiopathic constipation. Gastroenterol Clin North Am 1987; 16 (1) 143-156
    PubMedGoogle Scholar
  • 3 Beck DE. Initial evaluation. In: Wexner SD, Bartolo DCC, , eds. Constipation: Etiology, Evaluation, and Management. London: Butterworth-Heinemann; 1994: 31-38
    Google Scholar
  • 4 Beck DE. Simplified balloon expulsion test. Dis Colon Rectum 1992; 35 (6) 597-598
    CrossrefPubMedGoogle Scholar
  • 5 Pikarsky AJ, Singh JJ, Weiss EG, Nogueras JJ, Wexner SD. Long-term follow-up of patients undergoing colectomy for colonic inertia. Dis Colon Rectum 2001; 44 (2) 179-183
    CrossrefPubMedGoogle Scholar
  • 6 Pemberton JH, Rath DM, Ilstrup DM. Evaluation and surgical treatment of severe chronic constipation. Ann Surg 1991; 214 (4) 403-411, discussion 411–413
    CrossrefPubMedGoogle Scholar
  • 7 Todd IP. Constipation: results of surgical treatment. Br J Surg 1985; 72 (Suppl) S12-S13
    CrossrefPubMedGoogle Scholar
  • 8 Beck DE, Fazio VW, Jagelman DG, Lavery IC. Surgical management of colonic inertia. South Med J 1989; 82 (3) 305-309
    CrossrefPubMedGoogle Scholar
  • 9 Zenilman ME, Dunnegan DL, Soper NJ, Becker JM. Successful surgical treatment of idiopathic colonic dysmotility. The role of preoperative evaluation of coloanal motor function. Arch Surg 1989; 124 (8) 947-951
    CrossrefPubMedGoogle Scholar
  • 10 Wexner SD, Daniel N, Jagelman DG. Colectomy for constipation: physiologic investigation is the key to success. Dis Colon Rectum 1991; 34 (10) 851-856
    CrossrefPubMedGoogle Scholar
  • 11 Mahendrarajah K, Van der Schaaf AA, Lovegrove FT, Mendelson R, Levitt MD. Surgery for severe constipation: the use of radioisotope transit scan and barium evacuation proctography in patient selection. Aust N Z J Surg 1994; 64 (3) 183-186
    CrossrefPubMedGoogle Scholar
  • 12 Piccirillo MF, Reissman P, Wexner SD. Colectomy as treatment for constipation in selected patients. Br J Surg 1995; 82 (7) 898-901
    CrossrefPubMedGoogle Scholar
  • 13 Redmond JM, Smith GW, Barofsky I, Ratych RE, Goldsborough DC, Schuster MM. Physiological tests to predict long-term outcome of total abdominal colectomy for intractable constipation. Am J Gastroenterol 1995; 90 (5) 748-753
    PubMedGoogle Scholar
  • 14 FitzHarris GP, Garcia-Aguilar J, Parker SC , et al. Quality of life after subtotal colectomy for slow-transit constipation. Dis Colon Rectum 2003; 46: 433-440
    CrossrefPubMedGoogle Scholar
  • 15 Beck DE. Colectomy for colonic inertia. Clin Colon Rectal Surg 2005; 18: 81-84
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Nyam DC, Pemberton JH, Ilstrup DM, Rath DM. Long-term results of surgery for chronic constipation. Dis Colon Rectum 1997; 40 (3) 273-279
    CrossrefPubMedGoogle Scholar
  • 17 Lim JF, Ho YH. Total colectomy with ileorectal anastomosis leads to appreciable loss in quality of life irrespective of primary diagnosis. Tech Coloproctol 2001; 5 (2) 79-83
    CrossrefPubMedGoogle Scholar
  • 18 Vasilevsky CA, Nemer FD, Balcos EG, Christenson CE, Goldberg SM. Is subtotal colectomy a viable option in the management of chronic constipation?. Dis Colon Rectum 1988; 31 (9) 679-681
    CrossrefPubMedGoogle Scholar
  • 19 Krishnamurthy S, Schuffler MD, Rohrmann CA, Pope II CE. Severe idiopathic constipation is associated with a distinctive abnormality of the colonic myenteric plexus. Gastroenterology 1985; 88 (1 Pt 1) 26-34
    PubMedGoogle Scholar
  • 20 Glia A, Akerlund JE, Lindberg G. Outcome of colectomy for slow-transit constipation in relation to presence of small-bowel dysmotility. Dis Colon Rectum 2004; 47 (1) 96-102
    CrossrefPubMedGoogle Scholar
  • 21 Thaler K, Dinnewitzer A, Oberwalder M , et al. Quality of life after colectomy for colonic inertia. Tech Coloproctol 2005; 9 (2) 133-137
    CrossrefPubMedGoogle Scholar
  • 22 Hassan I, Pemberton JH, Young-Fadok TM , et al. Ileorectal anastomosis for slow transit constipation: long-term functional and quality of life results. J Gastrointest Surg 2006; 10 (10) 1330-1336 , discussion 1336–1337
    CrossrefPubMedGoogle Scholar
  • 23 Choe EK, Park SH, Park KJ. Colonic pseudo-obstruction with distinct transition zone in adult constipation patients: pathological analysis and results of surgical treatment. Am Surg 2011; 77 (6) 736-742
    PubMedGoogle Scholar
  • 24 Zutshi M, Hull TL, Trzcinski R, Arvelakis A, Xu M. Surgery for slow transit constipation: are we helping patients?. Int J Colorectal Dis 2007; 22 (3) 265-269
    CrossrefPubMedGoogle Scholar
  • 25 Hsiao KCW, Jao SW, Wu CC, Lee TY, Lai HJ, Kang JC. Hand-assisted laparoscopic total colectomy for slow transit constipation. Int J Colorectal Dis 2008; 23 (4) 419-424
    CrossrefPubMedGoogle Scholar
  • 26 Jiang CQ, Qian Q, Liu ZS, Bangoura G, Zheng KY, Wu YH. Subtotal colectomy with antiperistaltic cecoproctostomy for selected patients with slow transit constipation-from Chinese report. Int J Colorectal Dis 2008; 23 (12) 1251-1256
    CrossrefPubMedGoogle Scholar
  • 27 O’Brien S, Hyman N, Osler T, Rabinowitz T. Sexual abuse: a strong predictor of outcomes after colectomy for slow-transit constipation. Dis Colon Rectum 2009; 52 (11) 1844-1847
    CrossrefPubMedGoogle Scholar
  • 28 Pinedo G, Zarate AJ, Garcia E, Molina ME, Lopez F, Zúñiga A. Laparoscopic total colectomy for colonic inertia: surgical and functional results. Surg Endosc 2009; 23 (1) 62-65
    CrossrefPubMedGoogle Scholar
  • 29 Riss S, Herbst F, Birsan T, Stift A. Postoperative course and long term follow up after colectomy for slow transit constipation—is surgery an appropriate approach?. Colorectal Dis 2009; 11 (3) 302-307
    CrossrefPubMedGoogle Scholar
  • 30 Di Fabio F. Poor quality of life in patients undergoing total colectomy and ileorectal anastomosis for intractable slow-transit constipation. Dis Colon Rectum 2010; 53 (6) 959-960
    CrossrefPubMedGoogle Scholar
  • 31 Sohn G, Yu CS, Kim CW , et al. Surgical outcomes after total colectomy with ileorectal anastomosis in patients with medically intractable slow transit constipation. J Korean Soc Coloproctol 2011; 27 (4) 180-187
    CrossrefPubMedGoogle Scholar