Surgical treatment of severe constipation

Colonic impaction in dogs: a retrospective study of 58 cases (1996 to 2014)

OBJECTIVES

To describe the clinical findings, management and outcome of colonic impaction in dogs and report the effectiveness of medical treatment.

MATERIALS AND METHODS

Case records of 58 dogs with colonic impaction were reviewed. Telephone contact with the owners was used to obtain long-term outcome.

RESULTS

Twenty-nine dogs (50%) were mixed-breed, and 45 (78%) were entire males. Median age at presentation was 7 years, and median bodyweight was 22 kg. The degree of radiographic colonic distension did not appear to be related to long-term outcome. Fifty-five dogs (95%) received medical treatment including enemas alone, hyperosmotic and/or bulk-forming and/or lubricant laxatives, enemas combined with laxatives or enemas and/or laxatives combined with manual evacuation of faecal material under anaesthesia. Median survival time of the 58 dogs was 2 years. Overall, 36 of 41 dogs with available long-term follow-up had a favourable outcome.

CLINICAL SIGNIFICANCE

Medical treatment of colonic impaction in dogs with a single agent or a combination of agents has a high success rate. Marked colonic dilation is not necessarily indicative of megacolon in dogs.

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 constipation were assessed by Indium-111 DTPA colonic transit scan and barium evacuation proctogram. Patients were classified as having an isolated (I) or predominant disorder of colonic transit (II), a mixed disorder of colonic transit and rectal evacuation (III), a predominant disorder of rectal evacuation (IV) or normal colorectal emptying (V). Twelve patients 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 required re-operation for suspected anastomotic leak. One patient required readmission on two occasions for small bowel obstruction. Follow up has been 2-21 months (median 16). Eight of the nine patients no longer take oral aperients. Eight patients have a satisfactory stool frequency of 2-8 per 24 h; the other patient has an ileostomy and incapacitating postprandial abdominal pain. Abdominal pain is troublesome in two other patients. Two patients require antidiarrhoeal therapy but none experience faecal incontinence. In severely constipated patients with a proven disorder of colonic transit but normal or near normal rectal evacuation subtotal colectomy provides excellent symptomatic relief.

Impaired colonic motor response to cholinergic stimulation in patients with severe chronic idiopathic (slow transit type) constipation

Chronic idiopathic constipation, especially the slow transit type, is a troubling problem often afflicting young women. The pathophysiological basis for this entity is unknown, although a defective cholinergic innervation has been postulated. We tested the hypothesis that cholinergic colonic innervation is deranged in this condition by studying colonic motor activity after strong cholinergic stimulation with edrophonium chloride in 14 women complaining of slow transit constipation. Unlike healthy subjects, constipated patients showed minimal or no response to edrophonium injection. It is concluded that in slow transit constipation there is an important alteration of colonic cholinergic activity and that edrophonium chloride may represent a useful test drug for colonic pathophysiological investigations.