Back to 2011 Program

Introduction: Whole gut transit scintigraphy (WGTS) distinguishes isolated colonic from generalized GI motility disorders. Including WGTS in the pre-operative work-up allows appropriate diagnosis and management, and should be the standard of care for evaluation of colonic inertia. Our primary objective was to evaluate functional outcomes following colectomy for slow transit constipation in a single institution using preoperative scintigraphy. Secondary objectives were to describe predictive factors of outcome after surgery. Methods: After obtaining Institutional Review Board approval, we identified all patients who had surgery for colonic inertia from January 2003 to August 2010 using surgical billing codes and a GI departmental database. All patients who had WGTS prior to surgery were included in the analysis. Demographics, defecation, constipation details, pharmacologic treatment, symptoms, psychiatric medications, operation performed, and outcomes were extracted from a retrospective chart review and follow-up telephone interviews. Results: Fourteen patients had surgery for colonic inertia during the study period. Patients were mainly young females (86%, mean age 44.1 years) with a high coexistence of psychiatric disease (79%). The most common surgical intervention performed was total abdominal colectomy with ileoproctostomy (79%); 3 patients had an end ileostomy. WGTS results were available for 11 of 14 patients; 3 patients had their studies at an outside facility. All surgical patients had delayed 72-hour transit limited to the colon without coexistent gastric or small bowel delay on WGTS. Seven patients were available for follow-up interview at a median interval of 23 months. Post-operatively, 86% had complete resolution of pain and bloating, while 14% had considerable relief. Post-operative stool consistency was semi-solid in all patients. At follow-up patients reported between 2-5 bowel movements daily, while pre-operative frequency averaged one per week. No patients reported fecal incontinence or required anti-diarrheal medication after surgery. All patients contacted for follow-up reported that they were overall satisfied with the outcome of their surgery, claimed to feel better than before surgery, and would make the decision to have the procedure again. Conclusion: The diagnosis of colonic inertia mandates careful patient selection and may be improved with WGTS. We believe appropriate patient selection can optimize surgical outcomes. A pre-operative diagnostic regimen of WGTS and anal manometry combined with surgical intervention was associated with high patient satisfaction and improvement in constipation, abdominal pain, and bloating. Total abdominal colectomy with ileoproctostomy provides a satisfactory outcome for patients with colonic inertia, however, this should be offered only after thorough evaluation of whole gut transit time.