Conclusion
Many patients with IMM can be managed successfully with laxatives. In a few surgery is required. A subtotal colectomy with ileorectal anastomosis is the operation of choice if the bowel is not too dilated, with a good outcome in approximately 80% of patients. In those with a grossly dilated rectum, a Duhamel procedure is a reasonable alternative, but the results are not as satisfactory. A left iliac colostomy formed above the dilated bowel is an acceptable option for those patients happy to live with a stoma. Distal resection with coloanal anastomosis, or restorative proctocolectomy, are experimental procedures whose roles are yet to be defined. The selection of the right operation for the right patient depends on a very careful evaluation. This should include a psychological assessment, as many patients have intellectual, social or psychological problems. The upper gastrointestinal tract should be evaluated by at least a barium meal and follow through, to try and exclude patients who have idiopathic intestinal pseudo-obstruction. The anal sphincter should be assessed physiologically to detect those with a weak sphincter, in case diarrhoea or worsened incontinence supervenes postoperatively. Because these patients are uncommon and difficult to assess, they should be man-aged by practitioners with a special interest in the condition.
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References
Kamm MA (1989) Constipation. British Journal of Hospital Medicine 41:244–250
Preston DM, Lennard-Jones JE (1986) Severe chronic constipation of young women: idiopathic slow transit constipation. Gut 27:41–48
Waldron D, Bowens KL, Kingma YJ, Cote KR (1988) Colonic and anorectal motility in young women with severe idiopathic constipation. Gastroenterology 95:1388–1394
Bassotti G, Gaburri M, Imbimbo BP, Rossi L, Farroni F, Pelli MA, Morelli A (1988) Colonic mass movements in idiopathic chronic constipation. Gut 29:1173–1179
Kamm MA (1990) Role of surgical treatment in patients with severe constipation. Annals of Medicine 22:435–444
Krishnamurthy S, Schuffler MD (1987) Pathology of neuromuscular disorders of the small intestine and colon. Gastroenterology 93:610–639
Greydanus MP, Camillieri M, Colemont LJ, Phillips SF, Brown ML, Thomforde GM (1990) Ileocolonic transfer of solid chyme in small intestinal neuropathies and myopathies. Gastroenterology 99:158–164
Lake BD (1988) Observations on the pathology of pseudo-obstruction. In: Milla PJ (ed) Disorders of Gastrointestinal Motility in Childhood. John Wiley & Sons, Chichester New York Brisbane Toronto Singapore, pp 81–90
Preston DM, Lennard-Jones JE, Thomas BM (1985) Towards a radiological definition of idiopathic megacolon. Gastrointest Radiol 10:167–169
Barnes PRH, Lennard-Jones JE, Hawley PR, Todd IP (1986) Hirschsprung's disease and idiopathic megacolon in adults and adolescents. Gut 27:534–541
Lane RHS, Todd IP (1977) Idiopathic megacolon: a review of 42 cases. Br J Surg 64:305–310
McReady RA, Beart RW (1979) The surgical treatment of incapacitating constipation associated with idiopathic megacolon. Mayo Clin Proc 54:779–783
Belliveau P, Goldberg SM, Rothenberger DA, Nivatvongs S, (1982) Idiopathic acquired megacolon: the value of subtotal colectomy. Dis Colon Rectum 25:118–121
Parc R, Berrod JL, Tussiot J, Loygue J (1984) Le megacolon de l'adulte. A propos de 76 cas. Ann Gastroenterol Hepatol 20:133–141
Stabile G, Kamm MA, Hawley PR, Lennard-Jones JE (1991) Colectomy for idiopathic megarectum and megacolon. Gut (in press)
Stabile G, Kamm MA, Hawley PR, Lennard-Jones JE (1991) Results of the Duhamel operation in the treatment of idiopathic megarectum and megacolon. Br J Surg 78:661–663
Duhamel B (1956) Une nouvelle operation pour le megacolon congenital: l'abaissement retrorectal et transanal du colon et son application possible au traitment de quelques autres malformations. Presse Med 64:2249–2250
Duhamel B (1964) Retrorectal and transanal pull-through procedure for the treatment of Hirschsprung's disease. Dis Colon rectum. 7:455–458
Elliot MS, Todd IP (1985) Adult Hirschsprung's disease: results of the Duhamel procedure. Br J Surg 72:884–885
Stabile G, Kamm MA, Hawley PR, Phillips RKS, Lennard-Jones JE (1991) Alternative surgery for idiopathic megarectum and megacolon. Gut (in press)
Vernava AM, Robbins PL, Brabbee GW (1989) Restorative resection: coloanal anastomosis for benign and malignant disease. Dis Colon Rectum 32:690–693
Nicholls RJ, Kamm MA (1988) Proctocolectomy with restorative ileoanal reservoir for severe idiopathic constipation: report of two cases. Dis Colon Rectum 31:968–969
Hosie KB, Kmiot WA, Keighley MRB (1990) Constipation: another indication for restorative proctocolectomy. Br J Surg 77:801–802
Goligher J (1961) In discussion on megacolon and megarectum with emphasis on conditions other than Hirschsprung's disease. Proc R Soc Med 54:1053–1055
Hata Y, Sasaki F, Uchino J (1988) Sphincteromyectomy and sphincteroplasty in chronic constipation with megarectum. J Pediatric Surg 23:141–142
Barnes PRH, Lennard-Jones JE (1988) Function of the striated anal sphincter during straining in control subjects and constipated patients with a radiologically normal rectum or idiopathic megacolon. Int J Colorect Dis 3:207–209
Kamm MA, Hawley PR, Lennard-Jones JE (1988) Lateral division of the puborectalis muscle in the management of severe constipation. Br J Surg 75:661–663
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Stabile, G., Kamm, M.A. Surgery for idiopathic megarectum and megacolon. Int J Colorect Dis 6, 171–174 (1991). https://doi.org/10.1007/BF00341241
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DOI: https://doi.org/10.1007/BF00341241