Diagnosis and treatment of slow transit constipation complicated with adult megacolon / 中华胃肠外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To summarize the experience in the management of slow transit constipation complicated with adult megacolon.</p><p><b>METHODS</b>The clinical data of 32 above patients admitted between October 2007 and June 2011 were retrospectively studied.</p><p><b>RESULTS</b>Thirty-two patients were diagnosed as slow transit constipation according to the Roman III criteria. There were 15 males and 17 females aging from 18 to 56 years old. Sitz marker study showed prolonged colon transit time. Barium enema and defecography suggested bowel stricture locating in the transverse colon (n=3), descending colon (n=4), rectum (n=20), and concurrent transverse colon or descending colon and rectum (n=5). Anal manometry showed that anorectal inhibitory reflex was absent in 23 patients, while the other 9 patients were normal. Procedures performed included segmental colectomy and side-to-side anastomosis (n=1), subtotal colectomy and modified Duhamel anastomosis (n=16), total colectomy and ileal J-pouch Duhamel anastomosis (n=9). There were no postoperative complications. During the follow-up ranging from 3 to 47 months, defacatory function was excellent in 18, good in 9, and moderate in 5 patients.</p><p><b>CONCLUSIONS</b>Adult megacolon should be considered differential diagnosis of slow transit constipation. Detailed history taking and thorough evaluation of testing is the key to obviate misdiagnosis. Extent of resection should include the diseased dilated colon and slow transit colon.</p>