PDF(Pubmed)
Abstract：
Optimal surgical management of patients with intractable constipation and diffuse colonic motility is not well defined. We present a patient with such a history, who ultimately achieved successful surgical management of constipation through a stepwise approach. An 8-year-old female presents with longstanding constipation and diffuse colonic dysmotility demonstrated with colonic manometry. She initially underwent sigmoid resection and cecostomy which failed and required diverting ileostomy. We initially proceeded with an extended resection, colonic derotation (Deloyers procedure), and neo-appendicostomy (neo-Malone) which resulted in successful spontaneous stooling for 1 year. Her constipation recurred and she subsequently underwent completion colectomy with ileorectal anastomosis given that she previously demonstrated ability to stool independently. Six months from surgery the patient continues to stool daily with assistance of fiber and loperamide. This case highlights a stepwise surgical approach to managing constipation due to diffuse colonic dysmotility and demonstrates that diffuse dysmotility may benefit from an upfront subtotal resection; however, it is crucial to assess a patient\'s ability to empty their rectum prior.
摘要：
顽固性便秘和弥漫性结肠运动患者的最佳手术治疗方法尚不明确。我们提出一个有这样病史的病人，他最终通过逐步的方法成功地完成了便秘的手术治疗。结肠测压显示，一名8岁女性长期便秘和弥漫性结肠运动障碍。她最初接受了乙状结肠切除术和盲肠造口术，但失败了，需要转移回肠造口术。我们最初进行了扩大切除，结肠旋转(Deloyers程序)，和新阑尾造口术（neo-Malone）导致成功的自发性大便1年。她的便秘复发，随后她接受了完整的结肠切除术和回肠直肠吻合术，因为她以前证明了自己的大便能力。手术后六个月，患者在纤维和洛哌丁胺的帮助下每天继续大便。该病例强调了逐步的手术方法来治疗由于弥漫性结肠运动障碍引起的便秘，并证明弥漫性运动障碍可能受益于前期次全切除；然而，首先评估患者排空直肠的能力是至关重要的。
