Management der schweren idiopathischen Darmträgheit

Zusammenfassung

Bei der schweren idiopathischen Obstipation (sog. „slow transit constipation“) handelt es sich um eine seltene Erkrankung, die fast ausschließlich bei Frauen in der 3. und 4. Lebensdekade angetroffen wird. Pathophysiologie und Ätiologie dieser Erkrankung sind nur z. T. bekannt, wobei es sich offensichtlich um ein multifaktorielles Geschehen handelt. Differenzialdiagnostisch müssen mechanische, medikamentöse, degenerative, metabolische, endokrinologische, neurologische und psychiatrische Ursachen der Obstipation ausgeschlossen werden. Hierzu ist eine umfangreiche interdisziplinäre Abklärung erforderlich. Zudem müssen gastrointestinale Funktionsanalysen gefordert werden, wobei der Bestimmung der Kolontransitzeit eine Schlüsselrolle zufällt. Wichtig ist weiterhin der Nachweis bzw. Ausschluss einer pangastrointestinalen Passagestörung, einer Beckenbodendysfunktion oder eines Colon irritabile. Die Initialtherapie der Slow Transit Constipation ist grundsätzlich konservativ. Nur bei gut dokumentiertem Therapieversagen sollte eine operative Behandlung erwogen werden. Als Standardverfahren hat sich die subtotale Kolektomie mit ileorektaler Anastomose durchgesetzt. Wesentliche Komplikationen der operativen Therapie sind Dünndarmileus, Inkontinenz und Persistenz oder Rezidiv von Obstipation und Abdominalschmerzen. Bei korrekter Patientenselektion kann mit einer Erfolgsquote von über 80% gerechnet werden.

Abstract

Slow transit constipation is a rare condition that is almost exclusively encountered in middle-aged women. The pathophysiology and aetiology are poorly understood, but a multi-factorial pathogenesis seems likely. In the course of the differential diagnosis, mechanical, drug-induced, degenerative, metabolic, endocrinological, neurological and psychiatric causes of constipation must be excluded by an interdisciplinary approach. Gastrointestinal physiological investigations are mandatory, including measurement of colonic transit. Furthermore, pangastrointestinal transit delay, pelvic floor dysfunction and irritable bowel syndrome should be excluded. The initial mode of treatment is strictly conservative. In cases of progression or persistence of symptoms, surgical therapy should be discussed. Subtotal colectomy with ileorectal anastomosis can be regarded as the standard operation for slow transit constipation. Postoperative complications include small bowel obstruction, incontinence and persistence or recurrence of constipation and/or abdominal pain. Using strict criteria for patient selection, overall success rates are reported in excess of 80%.

Schlüsselwörter

idiopathische Darmträgheit - Obstipation

Key words

slow transit constipation - obstipation

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