[Severe obstipation in the mentally ill and disabled]

Severe constipation is a well recognized symptom amongst disabled or mentally ill patients. Characteristically, these patients live without bowel movements for days and present themselves with abdominal distension and fecal impaction. Inpatient treatment is necessary frequently. Due to intestinal obstruction, diagnostic approaches are often delayed because of lack of cooperation. Data of 94 disabled patients with severe obstipation are presented. 54 patients were admitted to inpatient treatment of constipation or bowel obstruction, 40 were treated for another diagnosis but had severe constipation which required intervention. Ileus or conservatively untreatable constipation led to 16 operations in 14 patients (polypectomy 2, rectopexy 1, cecostoma 5, left hemicolectomy 3, subtotal colectomy 5). Cecostomata are considered not to be effective as definite treatment whereas colonic resection resulted in daily bowel movements.