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Ann Surg. 1991 Oct;214(4):403-11; discussion 411-3.
Evaluation and surgical treatment of severe chronic constipation.

Pemberton JH, Rath DM, Ilstrup DM.

Department of Surgery, Mayo Medical School, Rochester, MN 55905.

Patients with chronic constipation may have one of several physiologic disorders, not all of which are amenable to operative therapy. The aim of this study was to test colonic and pelvic floor function preoperatively, to identify patients suitable for surgery based on these studies, and to determine operative outcome over time. Between 1987 and January 1991, 277 patients referred for severe symptoms of chronic intractable constipation underwent colon transit studies, measurement of anal canal pressures and reflexes, and measurements of anorectal angle movements and efficiency of evacuation. Balloon expulsion studies, electromyography of the pelvic floor, and defecating proctograms also were done. Based on these studies, patients were categorized as having: slow transit constipation (STC), 29 patients; pelvic floor dysfunction (PFD), 37 patients; STC + PFD, combined slow transit and pelvic floor dysfunction, 14 patients; and irritable bowel syndrome (IBS), 197 patients. Slow transit constipation patients underwent abdominal colectomy and reanastomosis. Pelvic floor dysfunction patients underwent pelvic floor retraining only. Patients with STC + PFD underwent pelvic floor retraining followed by abdominal colectomy. Irritable bowel syndrome patients were treated symptomatically. Among the 38 patients operated on (STC and STC + PFD), there was no operative mortality. Prolonged ileus developed in 13%, and small bowel obstruction occurred in 11% of patients. On follow-up, a mean of 20 months after ileorectostomy, no patient was constipated, none required a laxative, and none was incontinent. The mean number of stools per day was four. The authors concluded that a prospective evaluation of colonic and pelvic floor function reliably delineated constipated patients with slow transit, suitable for

Arch Latinoam Nutr. 1998 Jun;48(2):141-5.
[Estimated dietary fiber intake in children according to different food composition reference tables]

[Article in Portuguese]

Vitolo MR, Aguirre AN, Fagundes-Neto U, de Morais MB.

Departamento de Pediatria da Universidade Federal de Sao Paulo, Escola Paulista de Medicina.

The importance of dietary fiber intake in the prevention and treatment of adult diseases has been widely emphasized in the literature for several years. Recommendations for fiber intake by children have only recently began to be published. The present study estimated the fiber intake by children with or without constipation according to five food composition tables. We studied 114 children under 12 years of age, of whom 56 were constipated and 58 had normal bowel movements. We used a 24 hour recall questionnaire and fiber consumption was analysed by five food composition tables: 1. Association of Official Agricultural Chemist-AOAC, 2. Southgate, 3. Mendez, 4. Englyst and 5. crude fiber. The statistical analysis showed significant differences between the medians of the estimated fiber consumption calculated using all tables, except the AOAC and Southgate tables. The median value and percent is 25th and 75th presented between parenthesis were (grams/day): Mendez--15.4 (11.9-19.6); Southgate--10.5 (7.8-13.5); AOAC--10.2 (7.3-14.0); Englyst--4.5 (3.0-6.0) and crude fiber--2.1 (1.4-2.9). There were statistical significant correlations between all pairs of tables but the best correlation was observed between Mendez and Southgate (r = +0.90), AOAC and Southgate (r = +0.88); and Mendez and AOAC (r = +0.84). Constipated children presented lower estimated fiber intake than those with normal bowel movements, with statistical significance according to all tables. In conclusion, it is important to determine which reference table should be utilized when recommending dietary fiber.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9830489&dopt=Abstract constipation laxative colon cleansing

Eur J Surg. 1998 Oct;164(10):777-84.
Simple data from history and physical examination help to exclude bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain.

Bohner H, Yang Q, Franke C, Verreet PR, Ohmann C.

Department of General Surgery and Traumatology, Heinrich-Heine-Universitat, Dusseldorf, Germany.

OBJECTIVE: To assess the value of plain abdominal radiographs and of data from the medical history and physical examination in the diagnosis of acute abdominal pain in general and of bowel obstruction in particular. DESIGN: Prospective study. SETTING: 4 university and 2 community hospitals, Germany. SUBJECTS: 1254 patients with acute abdominal pain lasting less than 7 days, and with no history of abdominal injury including surgery. INTERVENTIONS: Standardised and structured medical history and physical examination, study of results of plain abdominal radiographs. MAIN OUTCOME MEASURES: Positive predictive value and sensitivity of clinical variables and abdominal film with respect to the diagnosis at discharge. RESULTS: 48 patients (3.8%) had bowel obstruction. 704 patients (56.1%) had plain abdominal films taken at the time of initial presentation. 111 studies (15.8%) showed important findings leading to diagnosis or immediate treatment, 455 (64.7%) showed unimportant or no findings. In 138 (19.6%) results of films were not reported. 16 of 45 single variables were of help in diagnosing bowel obstruction. The six with the highest sensitivity were distended abdomen, increased bowel sounds, history of constipation, previous abdominal surgery, age over 50, and vomiting. If only patients presenting with any two of these symptoms had had radiographs taken, 300 (42.6%) could have been avoided without loss in diagnostic accuracy. CONCLUSION: A considerable number of plain abdominal films taken for patients with acute abdominal pain could be avoided by focusing on clinical variables relevant to the diagnosis of bowel obstruction.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9840308&dopt=Abstract constipation laxative [PubMed - i

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