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Clinical features Symptoms include abdominal distension and vomiting akin to mechanical small bowel obstruction (see Chapter 78 ); however, colicky pain is less of a feature. On examination, other than evidence of the cause, e.g. recent surgery , the abdomen...

Constipation Definitions ‘Constipation’ is not a disease but rather a term often used by patients to describe dissatisfaction with their bowel function or their ability to defecate. As such it means di ff erent things to di ff erent patients (and di ff erent docto...

Diagnosis and management Megarectum may present with a mass the size of a full-term baby ( Figure 73.9 ) but diagnosis is mainly radiological. The mainstay of management of both (in brief) requires getting the rectum empty . In some patients with megarectum...

Diagnosis CT scanning is frequently required to exclude both mechanical obstruction and any local driver of ileus in the peritoneum such as inflammation or infection ( Figure 73.4 ). In instances of POI this is required to exclude local complications of surg...

FURTHER READING Bharucha A, Knowles CH. Chronic constipation. In: Sagar PM, Hill AG, Knowles CH eas et al. (eds). Keighley & Williams’ surgery of the anus, rectum and colon , 4th edn. Boca Raton, FL: Taylor & Francis, 2019: 305–46. Enck P , Aziz Q, Barbara G ...

Introduction No content extracted automatically.

Irritable bowel syndrome Surgery has no role in treating IBS. Nevertheless, patients with chronic abdominal pain and a change in their bowels are very common in surgical clinics and all surgeons should at least have a passing familiarity with a disorder that i...

Learning objectives To recognise and understand: The spectrum of intestinal disorders resulting from • abnormal neuromuscular functions The management of relatively common acute motility • disturbances

Management Ileus may be managed by nasogastric drainage and restriction of oral intake until there is evidence of improvement. Support - ive care such as attention to fluid and electrolyte balance and nutrition is also important, especially if ileus persists...

NEUROMUSCULAR STATES OF THE LARGE INTESTINE WITH DILATATION: ACUTE COLONIC PSEUDO-OBSTRUCTION Definition The term acute colonic pseudo-obstruction (ACPO) is defined /uni00A0 as: Acute massive dilatation of the colon with obstructive symptoms but in the absence o...

Pathophysiology Classic teaching points to a reflex inhibition of intestinal motility caused by deranged ANS inputs. This teaching, which fits nicely with basic ‘fight and flight’ concepts of increased sympathetic signalling and parasympathetic withdrawal during...

Prevention Minimally invasive surgical approaches have reduced risks of POI for many operations. The enhanced recovery programme (see Chapter 74 ) seeks to further reduce risk of POI by avoidance of opioid-containing drugs and suppression of the inflammatory...

Prognosis Prognosis is poor – sometimes considered the ‘motor neurone disease’ of the gut. Infantile forms have a mortality of approx imately 50%. This is generally lower in adult forms depending on cause and avoiding repeated surgery and overuse of opioid ...

Risk factors In Ogilvie’s original report, the clinical picture was associated with a retroperitoneal neoplasm infiltrating and destroying prevertebral ganglia. This is actually a very rare cause. The main risks are shown in Summary box 73.4 . Summary box 73.4 ...

SCOPE OF DISEASE A functional diagnosis is usually made when routine investigations - fail to find an easy explanation (e.g. a structural or biochemical - cause) for a combination of typical symptoms. For instance, in a patient with lower abdominal pain, cons...

SUMMARY Functional intestinal disorders range from the very common – constipation and IBS – through to the very rare, e.g. various genetic and familial neuropathies and myopathies causing IPO. The surgeon will almost certainly encounter acute problems - such ...

TESTS OF INTESTINAL FUNCTION Subsequent chapters address diagnostic tests specific to the rectum (see Chapter 79 ) and anus (see Chapter 80 ). Here the focus is on tests that may be relevant to studying the motility of the small intestine and colon. A general p...

ANATOMY OF THE SMALL INTESTINE Although the duodenum is anatomically indistinguishable from the rest of the small intestine, in surgical terms it may be regarded as a distinct structure and is discussed in Chapter 67 The small intestine lies between the duode...