Cases Of Chronic Constipation Research Articles

Intriguing case of fistula-in-ano presenting as corpora spongiosum abscess

A 77-year-old male, with a known history of diabetes mellitus for 10 years on alternative medication, known case of chronic constipation with hemorrhoids, and chronic lower urinary tract symptoms for many years, presented to the emergency with fever and chills for 2 days followed by acute urinary retention, which was relieved by insertion of Foley’s catheter. Eventually, he developed pain in the perianal region along with perianal discharge. On clinical examination, fistula-in-ano was evident. Magnetic resonance imaging was done for further evaluation which revealed fistula-in-ano communicating into a large abscess of corpus spongiosum of penis.

Effects of linaclotide in the treatment of chronic constipation and irritable bowel syndrome with constipation: a meta-analysis.

Linaclotide is a guanylate cyclase-C (GCC) agonist that is found in intestinal epithelial cells and is used when treating chronic constipation (CC) and irritable bowel syndrome with constipation (IBS-C). Several randomized controlled trials (RCTs) were conducted for evaluating its efficacy and safety. The PubMed, EMBASE, and Cochrane databases and the Web of Science were searched to find multiple RCTs of patients with CC or IBS-C. The Jadad scoring system was used for evaluating each study's methodological quality, and RevMan5.3 was used for meta-analysis. The composite endpoint reaction approved by the FDA, abdominal pain and discomfort relief, symptom improvement, and diarrhea-related adverse reactions were chosen as observation indicators, and relative risk (RR) and 95% confidence interval (CI) were obtained for quantitative and comprehensive evaluation. Eleven randomized controlled studies were included, consisting of 5 cases of CC and 6 cases of IBS-C. Linaclotide reached the composite endpoint response approved by FDA in the treatment of CC (RR = 3.26, 95% CI: 2.45-4.33), and the composite endpoint response approved by FDA for the treatment of IBS-C (RR = 2.26, 95% CI: 1.86-2.74) was greater than the placebo (both p < 0.00001). The main adverse reactions of linaclotide were gastrointestinal, mostly diarrhea, which was higher than that of the placebo when treating CC (RR = 3.56, 95% CI: 2.76-4.60) and IBS-C (RR = 8.23, 95% CI: 5.69-11.90) (both p < 0.00001). Linaclotide proved to be effective and safe for the treatment of CC and IBS-C compared to the placebo. However, diarrhea is the primary adverse reaction.

Laparoscopic Management of Perineal Descent Syndrome in Pediatric Age Group

ABSTRACT Background: Perineal descent syndrome is a disease that affects the pelvic floor because of denervation of its muscles, resulting in obstructed defecation. Hints on the anatomy that may be associated with the work got, and the physiology of the anorectum was explained, discussing factors leading to continence and mechanism of defecation was presented. Objective: to diagnose the perineal descent syndrome in both cases of chronic constipation and anal incontinence and the use of laparoscopy in the management of PDS in children where the pathophysiologic changes for each case is identified and dealt with laparoscopically. Patients and Methods: This study was a prospective case study that had been conducted in pediatric surgery department, Al-Azhar university hospitals during the period from June 2019 to June 2020 after approval from the ethical review committee of Al-Azhar faculty of medicine. The study included 30 patients presented to the outpatient clinics with constipation or Fecal incontinence whom fulfilled the required Criteria. Results: In our study (n=30), 2 recurrent cases (13.3%) were found after laparoscopic suture rectopexy. Recurrence rates with mesh rectopexy or resection rectopexy was zero % and chronic conistipation and fecal incontinence are considered as a hidden cause for perineal descent syndrome. Conclusion: The anterior rectal wall has a great dynamic role in defecation thanks to its viscoelastic properties. Any rectopexy technique should never interfere or impede this vital mechanism of action. Finally chronic conistipation and fecal incontinence are considered as a hidden cause for perineal descent syndrome.

Do bad habits bring a double constipation risk?

Good dietary habits, fluid intake, and regular exercise are considered to ease defecation although very few cases of chronic constipation can be managed through these approaches alone. Good defecation habits are recommended to avoid chronic constipation; however, the literature regarding this remains scarce. In this paper, we aimed to assess the association of bad habits concerning defecation, such as postponing, reluctance, or avoiding defecation anywhere but at home, with chronic constipation. This was a cross-sectional observational study including subjects from a tertiary hospital taskforce. In total, 415 of 910 eligible subjects were randomly selected. A cluster of questionnaires easy to understand and fill out was distributed. The questionnaires included queries regarding demographic data; past medical history; the presence of constipation; and dietary, other lifestyle, and defecation habits. The Rome III criteria for chronic constipation were also recorded. In total, 24.3% of the subjects considered themselves constipated, and 26.5% fulfilled the Rome III criteria for constipation. There were obvious differences in constipation prevalence by sex (men 5% vs. women 31%). Fiber-rich diet, fluid intake, and exercise habits were not related to constipation. Defecation habits significantly correlated with the presence or absence of constipation: regular schedule (OR 0.39; CI 95% 0.23-0.67), persistently postponing defecation (OR 1.94; CI 95% 1.13-3.34), or avoiding defecation anywhere but at home (OR 2.38; CI 95% 1.4-4.1). Compared with dietary habits, behavioral aspects surrounding defecation are more related to chronic constipation. Our results indicate that the modification of these bad habits may be the first step in chronic constipation treatment.

A case of chronic constipation which needed a multidisciplinary approach

A case of chronic constipation which needed a multidisciplinary approach

PWE-180 A Survey Evaluating General Practitioners’, Gastroenterologists’ And Experts’ Diagnostic Approaches To Inflammatory Bowel Disease, Irritable Bowel Syndrome And Chronic Constipation In Five European Countries

IntroductionThe confident diagnosis of chronic abdominal conditions can be challenging. This study assessed the diagnostic process in irritable bowel syndrome with constipation (IBS‑C), irritable bowel syndrome with diarrhoea (IBS‑D), inflammatory...

English

Abstract Introduction Rectal prolapse is a full-thickness protrusion of the rectum through the anal sphincter commonly seen in older people. In young people, rectal prolapse is uncommon. Any condition leading to increased intrabdominal pressure is contributory. This rectal prolapse is always an inconvenience for patient. This paper discusses a case of giant rectal prolapse. Case report A case of large rectal prolapse in a 25-year-old male is reported. The patient had a recurrent prolapse and was managed conservatively each time. He had a known case of chronic constipation. Conclusion Large rectal prolapse in young people is rare. Chronic constipation is commonly seen in rectal prolapse. Surgery is the treatment.

Abnormalities of digestive tract innervation in rat fetus treated with ethylenethiourea

The pathophysiology of abnormalities associated with myenteric plexus lesions remains imperfectly understood. Such abnormalities have been correlated with subocclusive intestinal conditions in children with Hirschsprung's disease, cases of chronic constipation and, postoperatively, in cases of anorectal anomalies. This study evaluated abnormalities of the myenteric plexus in fetus from female rats that received ethylenethiourea. Female rats were exposed to ethylenethiourea on the 11(th) day of pregnancy (experimental group) or to 0.9% physiological solution (control group). Abnormalities were only found in the experimental group. The digestive tract muscle layer was analyzed morphometrically and changes to the frequencies of nerve plexus cells and interstitial cells of Cajal were evaluated, using hematoxylin-eosin, S-100 protein, neuron-specific enolase and C-Kit, respectively. Muscle and skeletal abnormalities were observed in 100%, anorectal anomalies in 86%, absent tail in 71%, short tail in 29%, duodenal atresia in 5%, esophageal atresia in 5% and persistent omphalomesenteric duct in 5%. Histopathological analysis showed a thinner muscle layer associated with lower frequencies of ganglion cells and interstitial cells of Cajal, in all gastrointestinal tract. Severe nerve plexus abnormalities associated with muscle layer atrophy were observed throughout the gastrointestinal tract in newborn rats exposed to ethylenethiourea.

An unusual pediatric case of chronic constipation and rectosigmoid prolapse diagnosed by video defecography

Rectal prolapse is a relatively common, benign condition in the pediatric population. Conservative management usually results in resolution of the problem. Persistent rectal prolapse with chronic constipation suggests more serious underlying pathologic condition that may be challenging to diagnose. We present a case of severe recurrent rectal prolapse with chronic constipation in a 13-year-old boy. Using video defecography, an unusual radiographic modality in children, a functional sigmoid obstruction was observed that was not found on more routine imaging studies. Laparoscopic sigmoidectomy provided an excellent outcome in this patient who previously had a lifestyle-limiting, chronic condition.

Desmosis of the colon: a working hypothesis of primary chronic constipation.

Over the last few years, resected specimens of colon from children and young adults have been systematically studied with regard to the vegetative innervation of the colon and its net of stabilizing connective tissue in the muscularis propria. From the basic investigations of Goerttler, it is known that this connective tissue net has important functions in the coordinated movement of longitudinal and circular muscles. The present study reports on cases of chronic constipation, which showed in most cases histopathologically a normal number of nerve cells and ganglia in the myenteric plexus, but abnormalities in the connective tissue net (desmosis). Over 6 years, 236 cases (12 +/- 8 years of age), which were treated surgically for an aganglionosis, hypoganglionosis, hypoperistalsis syndrome and megacolon development, were histopathologically investigated. All surgical specimens were native, caudo-cranially coiled, and were cut 15 microns (equiv. to 4-5 microns paraffin sections) by a cryostat. The vegetative nervous system of the gut was stained with acetylcholinesterase and dehydrogenase reactions. The tissue was also fixed in formalin, embedded in paraffin, and 4 microns sections were stained with hematoxylineosin and picric acid/sirius red. Collagen III; S 100 and PGP 9.5 immunohistochemical reactions were performed. 14 surgical specimens (6%) showed total or focal lack of the connective tissue net in the vicinity of the myenteric plexus. Between the connective tissue net of circular and longitudinal muscles, a continuous connection was missing. These cases were mainly characterized by a hypoperistalsis syndrome or a megacolon without any anomaly of the vegetative innervation. 222 cases (94%) were treated for Hirschsprung's disease or hypoganglionosis without any anomaly of the connective tissue of the muscularis propria. The missing continuity of the connective tissue net in the muscularis propria seems to abolish coordinated alternative movement of circular and longitudinal muscles. Therefore, the lack of coordinated propulsive activity of the colon results in a therapy-resistant chronic constipation, with a hypoperistalsis syndrome.

Sensory discrimination training in the treatment of a case of chronic constipation

A 31-year-old woman with a history of life-long constipation and laxative dependence was treated with discrimination training for rectal sensation. She had complained of absence of the urge to defecate, bloating with abdominal discomfort, and need for laxatives to relieve symptoms. Manometric examination with an anorectal balloon assembly revealed a normal threshold for sphincteric reflexes, but an abnormally elevated threshold for detection of rectal distention. Behavioral treatment consisted of a manometrically based sensory discrimination procedure designed to reduce the sensory threshold for rectal distention. Multiple training sessions with this procedure allowed recognition of progressively smaller rectal distention volumes. Accompanying these changes in rectal sensory threshold were concomitant increases in the frequency of bowel movements, decreases in the weekly use of laxatives, and decreases in subjective discomfort. Therapeutic effects were maintained at follow-up examination one year later. The results of this case study suggest that behavioral training to increase rectal sensation may be useful in treating constipation in patients who have abnormal rectal sensory thresholds.

Diagnosis of congenital neurogenic abnormalities of the bowel with monoclonal anti-neurofilament antibodies

The diagnostic properties of two monoclonal, antineurofilament antibodies were tested in a retrospective investigation of bowel specimens of 24 cases of Hirschsprung's disease, eight cases of long-segment aganglionosis, eight cases of pseudo-obstruction, and six cases of chronic constipation. Immunohistochemical staining with the antibodies in combination with hematoxylin counterstaining revealed six distinctive and divergent pictures, demonstrating innervation disturbances in all cases. Apart from Hirschsprung's disease and long-segment aganglionosis, characteristic pictures also appeared for pseudo-obstruction and, diversely, for chronic constipation. In addition, anomalies were revealed in the ganglionic, proximal bowel of five patients with Hirschsprung's and two with long-segment aganglionosis, who had all suffered from chronic constipation postoperatively.

Observations on the Effect of B. Acidophilus Milk upon Cases of Chronic Constipation

Observations on the Effect of B. Acidophilus Milk upon Cases of Chronic Constipation