ANTEGRADE ENEMAS FOR THE TREATMENT OF SEVERE IDIOPATHIC CONSTIPATION

The technique of appendicocaecostomy produces a continent catheterizab le channel through which colonic washouts are given. This procedure wa s performed on six women of mean age 33.5 years with severe idiopathic constipation (mean stool frequency less than 1 per week) resistant to medical therapy. All patients had prolonged colonic transit times, th ree had evidence of obstructed defaecation and all had reduced or abse nt voluntary anal squeeze pressure. Patients found the appendicocaecos tomy and catheterization acceptable, and symptoms of abdominal distens ion and pain resolved. All patients were able to initiate defaecation and evacuate the colon within Ih of irrigation, and no patient had app reciable incontinence. Irrigation was necessary every 48-72 h. Adults with intractable constipation and pelvic floor weakness would be at ri sk of faecal incontinence after ileorectal anastomosis; it is in these patients that appendicocaecostomy has potential for the greatest bene fit.