LETTER
Clinical Management of the Constipated Patient
Mark P. Runde
15 April 1995 | Volume 122 Issue 8 | Page 632
TO THE EDITOR:
The article by Camilleri and colleagues [1] provides an excellent review of chronic constipation. In their review of current treatment options for severe constipation, the authors mention the study of Pemberton and coworkers [2], in which patients followed for 2 years had a mean of 4 bowel movements per day with no incontinence. I caution readers that, despite these excellent results, surgical ileorectostomy for severe constipation in the setting of a slow transit time should be done with caution. A patient seen in my practice was treated 3 years ago with ileorectostomy and now has an average of 16 bowel movements per day, sometimes with incontinence, and has experienced substantial limitations to her lifestyle. I caution physicians recommending this surgery to be aware of the severe complications that may ensue.
1. Camilleri M. Clinical management of intractable constipation. Ann Intern Med. 1994; 121:520-8.
2. Pemberton JH, Rath DM, Ilstrup DM. Evaluation and surgical treatment of severe chronic constipation. Ann Surg. 1991; 214:403-13.
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