IDIOPATHIC MOTILITY DISORDER OF THE BOWEL

Introduction. Motility disorder of the bowel is rare and complex. Progress has been made towards establishing the diagnosis but unfortunately it does not translate into improved patient care. Often patient spend years on laxatives before surgical options are considered. For the sake of simplicity; this condition is divided in three categories: Motility disorder of the bowel (colonic inertia), functional pelvic outlet obstruction and combination thereof which further subdivides into congenital and acquired. Objective. To present the unusual cases of idiopathic motility disorder of the bowel in order to reflect on its challenging management Method. Retrospective review of 6 cases treated at Chris Hani Baragwanath Academic Hospital from 2007 to 2010. Parameters studied: patient demographics, clinical presentation, time of onset, management, investigations and outcome. Result. 6 cases of chronic constipation. All of black African origin. Mean age of 18 years (11-32), predominantly male with a 5:1 ratio. 5 patients presented with severe constipation (1 stool per month) since birth and one patient had acquired constipation. Their mainstay of treatment has been chronic laxatives with insignificant benefit. 5 patients had total colectomy (of which one as an emergency) and one had segmental resection. All patients improved except the only one in the acquired limb who relapsed and the condition progressed proximally in the small bowel. In the congenital limb, 4 patients are off laxatives and one had partial response and remains laxative dependent. There was no evidence of any pathology on histology. Conclusion. Rare condition with unknown aetiology and difficult to manage. Surgery offers satisfactory result in selected cases