Laparoscopic Loop Ileostomy for Severe Refractory Slow-Transit Constipation in a Patient With Charcot-Marie-Tooth...

Severe constipation may cause profound disability despite daily bowel movements. Surgical decision-making is particularly challenging when gastrointestinal dysmotility coexists with neuromuscular disease and impaired functional independence. A 60-year-old man with Charcot-Marie-Tooth (CMT) disease type 2 and wheelchair dependence spent four to five hours per day toileting despite osmotic laxatives and intermittent enemas. His distress and loss of independence had led him to seek access to voluntary assisted dying (VAD) services. Colonoscopy identified no obstructing colorectal lesion. Whole-gut transit testing showed preserved proximal transit, delayed colonic transit, and possible delayed rectal emptying. Formal anorectal physiology testing was not completed. Following shared decision-making with the patient, family, colorectal surgeons, and stomal therapy clinicians, he underwent laparoscopic loop ileostomy on April 2, 2026. Laparoscopy demonstrated minor omental adhesions, caecal adherence to the right abdominal wall, and dilated, flaccid bowel with reduced tone but some residual peristaltic activity. Early recovery included urinary retention. Ileostomy output decreased from 1.8 to 0.9 L/day after loperamide and psyllium were commenced. By postoperative day seven, he had changed his own appliance and was medically ready for discharge, pending stomal therapy clearance. At two months, he reported independent stoma management, bowel care taking minutes, and improved daily function and quality of life. Slow-transit constipation and colonic inertia should not be treated as interchangeable diagnoses or as evidence of a specific neuromuscular lesion. Loop ileostomy may offer a potentially reversible diagnostic and therapeutic trial when the benefit of colectomy is uncertain, although longer-term follow-up is needed to assess its durable benefit.