Subtotal colectomy for severe idiopathic constipation. A follow-up study of 13 patients.

We obtained follow-up information on 13 patients who underwent subtotal colectomy for severe idiopathic constipation 19-45 months previously. Stool frequency increased from one bowel movement per 11.5 days before colectomy to 5.3 bowel movements per day after colectomy. Nine patients have required readmissions for abdominal pain and four have required further surgery for symptoms of small bowel obstruction. Ten patients consider that their quality of life is improved, although five have variable amounts of fecal incontinence. Preoperative studies did not predict the three patients who failed to improve. Subtotal colectomy palliates constipation in most patients with severe idiopathic constipation but patients should be cautioned that not all improve and some are left with significant abdominal pain, obstructive symptoms, diarrhea, and fecal incontinence.

Visceral myopathy of the colon mimicking Hirschsprung's disease. Diagnosis by deep rectal biopsy.

A 51-year-old man presented with a history and physical findings consistent with adult Hirschsprung's disease. An inadvertent transmural rectal biopsy led to the unexpected diagnosis of a visceral myopathy, a diagnosis which was confirmed by subsequent colectomy. The pathological findings are reviewed, and the potential use of transmural rectal biopsy in the diagnosis of smooth muscle disorders of the colon is discussed.

Chronic intestinal pseudoobstruction as a complication of Duchenne's muscular dystrophy.

We report a case of Duchenne's muscular dystrophy complicated by intestinal pseudoobstruction. The patient had recurrent attacks of nausea, vomiting, and abdominal distention for many years, and abdominal films repeatedly showed a dilated and fluid-filled small intestine and colon. Barium studies showed an esophageal diverticulum, reduced esophageal and gastric motility, and a dilated small bowel and colon. Pathologically, the entire gastrointestinal tract had smooth muscle fibrosis, but this was most marked in the esophagus and stomach. We conclude that Duchenne's muscular dystrophy may involve intestinal smooth muscle and produce pseudoobstruction.

Intestinal pseudoobstruction caused by a new form of visceral neuropathy: palliation by radical small bowel resection.

We report a case of chronic intestinal pseudoobstruction caused by a newly recognized type of degenerative neuropathy of the myenteric plexus. Failure to improve despite aggressive medical management led to radical resection of the clinically involved small intestine. At follow-up 10 mo later, the patient is doing well without the need for parenteral nutrition. Radical resection of the small intestine may be necessary for palliation in rare patients with intractable pseudoobstruction.