Intestinal Disorders 2008 [antikvár]

Outiét obstruction: Diagnosis and treatment 2008 Ferenc Jakab, MD, DSC Professor of Surgery, LJzsoki Teaching Hospitál, Budapest, Hungary The outiét obstruction syndrome (OOS) by definition encompasses all pelvic floor abnormalities, which are responsible for an incomplete evacuation of fecal contents from the rectum. The prevalence of constipation in adults may be as high as 28%, accounting for more than 2.5 millión outpatient medical visits in the U.S. yearly. The OOS may be observed in half of constipated patients. The types of constipation cover the slow transit colonic constipation, the outiét obstruction and the combination of the previous two. The causes of outiét obstruction can be devided to functional and morphological origin. The outiét obstruction with morphological causes mainly should be treated surgically. The diagnosis of outiét obstruction is basically achieved by bárium X-ray defecography, anorectal manometry, electromyography (EMG) and dynamic MR imaging. Treatment of OOS is dependent on the causes of the syndrome. OOS originating from functional causes (anismus, Hirschprung's disease, hereditary internál sphincter myopathy, central nervous lesions, Parkinson's disease) are treated conservatively (botulinum toxin directly into the puborectal muscle) There is place to progressive dilatation also. The standard laxative treatment consist of buik laxatives (fiber, psyllium, polycarbophil, methylcellulose) lubricating laxatives, stimulating laxative (surface acting agents, diphenylmethan, ricenoleic acids, anthraquinones) and osmotic agents (magnesium and phosphate salts, sorbitol lactulose, polyethylene glycol PEG) The dietary fiber treatment should be conducted before investigations, which would be indicated only if fiber fails. The multimodal therapy includes PEG, colchicines, misoprostil and additionally there are neurotropic factors under investigations. Surgical interventions are numerous, covering wide rangé of interventions from endorectal repair of rectocele through stapler assisted transanal surgery to proctoclectomy with restorative ileo - anal reservoir. If the patient is unresponsive to conservative treatment, different surgical options should be taken in to careful consideration. The repair of specific anatomic defects are indicated if the absence of primarily colonic obstipation is proven. Moreover, patients with impaired sphincter function should be excluded due to the high risk of inducing definitive postoperative incontinence. Different surgical options have been proposed such as vaginal or perineal levatorplasty, open or laparoscopic retropexias, resection - rectopexy, transrectal or endorectal resection. The detailed surgical indications are hot spots in 2008. The pathophysiology of outiét obstruction syndrome is still far to be clearly understood, for this reason surgery should be taken into consideration as carefully as possible.