Proctocolectomy with restorative ileoanal reservoir for severe idiopathic constipation. Report of two cases

The standard surgical therapy for severe idiopathic constipation remains total colectomy with ileorectal anastomosis, but approximately 10 percent of patients develop recurrent severe constipation. The authors have performed rectal excision and formation of an ileal reservoir with ileoanal anastomosis in two patients in whom constipation followed colectomy. Both patients experienced symptomatic relief, and in one patient there was objective improvement in transit studies, sensory testing, and proctography. In both patients a permanent ileostomy was avoided.