SURGERY FOR SEVERE CONSTIPATION - THE USE OF RADIOISOTOPE TRANSIT SCAN AND BARIUM EVACUATION PROCTOGRAPHY IN PATIENT SELECTION

Nineteen women aged 19-64 years (median 38) with intractable constipat ion were assessed by Indium-111 DTPA colonic transit scan and barium e vacuation proctogram. Patients were classified as having an isolated ( I) or predominant disorder of colonic transit (11), a mixed disorder o f colonic transit and rectal evacuation (III), a predominant disorder of rectal evacuation (IV) or normal colorectal emptying (V). Twelve pa tients fell into categories I and II and were considered suitable for surgery. Three responded to further vigorous aperient therapy and nine (32-55 years, median 38) underwent subtotal colectomy with ileorectal anastomosis at the level of the sacral promontory. Two patients requi red re-operation for suspected anastomotic leak. One patient required readmission on two occasions for small bowel obstruction. Follow up ha s been 2-21 months (median 16). Eight of the nine patients no longer t ake oral aperients. Eight patients have a satisfactory stool frequency of 2-8 per 24 h; the other patient has an ileostomy and incapacitatin g postprandial abdominal pain. Abdominal pain is troublesome in two ot her patients. Two patients require antidiarrhoeal therapy but none exp erience faecal incontinence. In severely constipated patients with a p roven disorder of colonic transit but normal or near normal rectal eva cuation subtotal colectomy provides excellent symptomatic relief.