Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, refractory constipation characterized by infrequent bowel movements (less than 3 per week), requiring manual disimpaction or chronic laxative dependence. Reports persistent abdominal bloating, discomfort, and a sensation of incomplete evacuation. Symptoms are unresponsive to high-fiber diet, osmotic laxatives, and prokinetic agents. No evidence of mechanical obstruction or pelvic floor dyssynergia.
Clinical Examination Findings
Abdominal examination reveals generalized distension with tympany on percussion. Palpation demonstrates diffuse tenderness without rebound or guarding. Bowel sounds are hypoactive. Digital rectal examination (DRE) shows an empty rectal vault, absence of fecal impaction, and normal anal sphincter tone. No evidence of rectal prolapse or rectocele.
Treatment Protocol
Surgical intervention indicated due to failure of maximal medical therapy. Plan: Subtotal colectomy with ileorectal anastomosis (IRA). Pre-operative bowel preparation and nutritional optimization initiated. Post-operative management includes early mobilization, gradual advancement of diet, and monitoring for electrolyte imbalances and diarrhea.