SEGMENTAL COLECTOMY IN THE MANAGEMENT OF COLONIC INERTIA

Subtotal colectomy with ileorectostomy has been proposed for the manag ement of colon inertia-type constipation. However, many patients exper ience frequent bowel movements, watery diarrhea, or both after such a treatment. The purpose of this study is to determine the proper colect omy with which to treat colon dysmotility constipation without the neg ative side effects of frequent bowel movements, watery diarrhea, or bo th. Forty idiopathic constipation patients were studied. All of the pa tients showed a prolonged right or left colon transit time and normal transit time of the sigmoid and rectum. They received different types of colectomies (left, right, and subtotal) according to the distributi on or accumulation of markers in the colon. Within 3 months of surgery , all of the patients experienced a dramatic improvement of their symp toms without frequent bowel movements or watery diarrhea. No significa nt complications developed after surgery. All the patients were follow ed up for at least 2 years. Most of them (37 cases) still had satisfac tory bowel movements and no other constipation symptoms. However, 3 of the 40 cases developed symptoms of constipation 11/2 to 2 years after surgery. They all received subtotal colectomy with ileorectal anastom osis subsequently. They reobtained satisfactory bowel movements and ex perienced a subsidence of other constipation symptoms 3 months later. These results suggest that directed segmental colectomy can improve co lonic inertia constipation without the consequence of frequent bowel m ovements and diarrhea.