Constipation is a common encounter in surgical practice. The cause of the constipation in a surgical patient may be due to a diverse spectrum of causes. In some cases, an event of constipation may occur after the operative procedure. In other cases, Constipation may be the primary problem that makes a patient to seek a medical attention.
Constipation may occur in early infancy. There are a number of causes that can lead to constipation after birth. The causes include congenital adhesive bands and hernia (internal and external). Hirschsprung disease is another cause that needs a prompt surgical intervention such as colostomy. The child is followed by a definitive operation in later life. Other causes include intussusception and polyps. As the age of patient advances, more and more cases of constipation are seen by surgeons. The causes include intussusception, postoperative adhesions and neoplasia. Constipation may present as a lone symptom or it may present as part of the signs and symptoms of intestinal obstruction. In case of intestinal obstruction, there are vomiting and severe pain that cause the patient to seek medical treatment early. In case of neo plasm like colorectal carcinoma, the patient may come to surgeon only when there is absolute constipation. Colorectal carcinoma is a serious medical condition but can be cured if treated in early stage. The most common constipation cases are found in post-operative periods. They are due to postoperative pain, effects of Anaesthesia and other drugs, and fluid and electrolyte imbalance.
Exact Diagnosis of the constipation is the key to successful management. Thorough history taking and proper physical examination including digital rectal examination is a must in the quest of the underlying problem. Important investigations like CT, MRI and colostomy must be done as necessary.
Treatment of constipation may be conservative or surgical depending on the diagnosis. Some of the postoperative constipations respond well to proper conservative treatment.
More serious conditions such as colorectal cancer and extensive adhesions will need proper laparotomy. Surgical procedures may vary from adhesiotomy to excision and reconstruction of the effected organ.
In some malignant conditions, complete excision may not be possible. Palliative procedures like stomas and bypass can be considered in such cases.
Surgeons see constipated patients in their daily practice. The cause may range from simple benign peritoneal ileus to a severe life threatening malignancy.
A careful and step by step workup of the patient will reveal the diagnosis. An appropriate management (surgical or otherwise) will help the patient to overcome the problem.
References
- Williams SB, Greenspon J, Young HA,Orkin BA, Small bowel obstruction: Conservative vs surgical management. Dis Colon Rectum 2005; 48: 1140-6.
- Wolthuis AM, Bislenghi G, Fieuws S et al.(2016) Incidence of prolonged postoperative ileus after colorectal surgery: a systematic review and meta-analysis. Cilorectal Dis 2016; 18(1):O1-9.
Author Information
Thein Lwin
M.B.,B.S; M.Med.Sc (Surgery); FRCS
Retired Professor of Surgery
University of Medicine (1) Yangon / Yangon General Hospital
