Selection of constipated patients as subtotal colectomy candidates

Douglas K. Rex, John C. Lappas, Robert C. Goulet, James A. Madura

Research output: Contribution to journalArticle

18 Scopus citations


We evaluated 224 consecutive patients referred for severe constipation prospectively by strict criteria to determine their candidacy for subtotal colectomy. Eighteen patients had insufficient symptoms to warrant evaluation. Two hundred six patients had anorectal manometry and defecography, and 182 had colonic transit measurement. Forty-nine patients had normal or minimally abnormal studies. One-hundred twenty-nine patients had abnormalities such as outlet obstruction, mild colonic inertia, diffuse gut dysfunction, or combinations of factors not favoring subtotal colectomy. Twenty-eight patients had colonic inertia without outlet obstruction and with disabling symptoms; 19 of these patients underwent subtotal colectomy. Follow-up 12 months was available in 14 patients from this group. Of these patients, 12 (86%) were clinically improved. Preoperative evaluation accurately predicted postoperative fecal incontinence and likely reduced postoperative constipation. Small-bowel obstruction occurred postoperatively in 4 patients (29%), and remains a major risk of subtotal colectomy even in carefully selected candidates.

Original languageEnglish (US)
Pages (from-to)212-217
Number of pages6
JournalJournal of Clinical Gastroenterology
Issue number3
StatePublished - Oct 1992


  • Anismus
  • Anorectal manometry
  • Colonic inertia
  • Constipation
  • Defecography
  • Subtotal colectomy

ASJC Scopus subject areas

  • Gastroenterology

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