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Scintigraphic assessment of slow transit constipation with special reference to right- or left-sided colonic delay
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
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2004 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 6, no 6, 499-505 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Subtotal colectomy and ileorectal anastomosis for slow transit constipation has several side-effects. The motor abnormality in some patients may be segmental which could motivate a limited resection of the colon. Therefore a diagnostic tool to identify a segmental colonic motor dysfunction is needed. The aim of this study was to evaluate a scintigraphic method to assess colonic transit with special reference to right- or left-sided delay. METHODS: Twenty-three constipated patients (19 women, mean age 50 years) with slow colonic transit on radio-opaque marker studies and 13 healthy individuals (11 women, mean age 46 years) were studied. All subjects were examined with oral (111)Indium-DTPA scintigraphy. The scintigraphic results for patients and controls were presented as geometric centre of radioactivity and percent activity over time in the right, the left and the recto-sigmoid colon. The inter-observer variation in the interpretation of the scans was also evaluated. RESULTS: There was no difference in transit time between the groups of patients and controls in the right colon whereas the patients had a significant delay in the left colon (P < 0.05). Two patients had a marked delay in the right colon followed by relatively rapid transit in the left colon. The inter-observer correlation was good comparing the right, the left and the recto-sigmoid colon (r = 0.58-0.98, P < 0.01-0.001). CONCLUSION: The results indicate that colonic scintigraphy with oral (111)Indium-DTPA may help to select patients for a left or, in a few cases, a right hemicolectomy for slow transit constipation.

Place, publisher, year, edition, pages
2004. Vol. 6, no 6, 499-505 p.
Keyword [en]
Adult, Aged, Case-Control Studies, Colon/physiology, Comparative Study, Constipation/physiopathology/*radionuclide imaging/surgery, Female, Gastrointestinal Transit/*physiology, History; Medieval, Humans, Indium Radioisotopes/*diagnostic use, Male, Manometry, Middle Aged, Observer Variation, Probability, Prospective Studies, Reference Values, Sensitivity and Specificity, Severity of Illness Index, Statistics; Nonparametric, Time Factors
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URN: urn:nbn:se:uu:diva-92963DOI: 10.1111/j.1463-1318.2004.00694.xPubMedID: 15521943OAI: oai:DiVA.org:uu-92963DiVA: diva2:166298
Available from: 2005-05-03 Created: 2005-05-03 Last updated: 2016-04-29Bibliographically approved
In thesis
1. Slow Transit Constipation: Aspects of Diagnosis and Treatment
Open this publication in new window or tab >>Slow Transit Constipation: Aspects of Diagnosis and Treatment
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Oral 111-Indium-DTPA colonic scintigraphy was used to assess segmental transit in 23 patients with slow transit constipation (STC) and 13 controls. The transit time did not differ between patients and controls in the right colon, whereas the patients had a consistent delay from the transverse colon and distally (P<0.05–0.001). Two individual patients had a delay in the right colon.

Twenty-eight patients underwent a left- (n=26) or a right (n=2) hemicolectomy for STC, after evaluation including colonic scintigraphy. Twenty-three patients (80%) were satisfied with the outcome after a median of 50 months. The median stool frequency increased from one to seven per week (P<0.001). The number of patients with bloating, excessive straining and painful defecation decreased (P<0.05). The laxative use decreased (P<0.01) and faecal continence was unchanged. A blunted rectal sensation correlated to a poor outcome.

Fifty constipated patients with slow colonic transit and 28 controls were investigated with anorectal manovolumetry. Anal resting pressure was lower (P<0.05), and squeeze pressure tended to be lower (P=0.09) in patients. Rectal sensation was not different between groups, although ten patients had a threshold for filling sensation above the 95th percentile of controls. The rectal compliance was increased in patients (P<0.05–0.01).

Total and segmental colonic transit was assessed with radio-opaque marker study and scintigraphy in 35 constipated patients, and related to normal values. Twenty-seven of 31 female patients had a prolonged total transit time on marker study, and 26 on scintigraphy. Of those 31 patients, 29 had prolonged segmental transit only in one or two segments on marker study. The two methods gave a similar result, except in the descending colon (P<0.05). However, the results varied considerably for individual patients.

In conclusion, patients with STC often benefit from a segmental colonic resection, following assessment including scintigraphy. Anorectal physiology testing may predict surgical results.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 59 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 31
Surgery, colectomy, constipation, radio-opaque markers, rectal compliance, rectal sensation, scintigraphy, segmental colonic resection, segmental colonic transit, sphincter pressure, Kirurgi
National Category
urn:nbn:se:uu:diva-5770 (URN)91-554-6230-8 (ISBN)
Public defence
2005-05-24, Grönwallsalen, Akademiska sjukhuset, Ingång 70, Akademiska sjukhuset, Uppsala, 13:15
Available from: 2005-05-03 Created: 2005-05-03Bibliographically approved

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