Can surgery cure my Slow Transit Constipation and IBS-C?

1. Food poisoning from takeaway sushi 3 months prior to getting IBS symptoms
2. Experienced intense anxiety/panic attack at work for 1/2 hr(I broke some expensive equipment) a month prior to getting IBS symptoms
3. Drank 30 ~ 70 ml of 1 year old opened red wine. Within 5 minutes, it gave me an intense upper abdominal pain for 10 minutes a week prior to getting IBS symptoms
4. Started getting mild abdominal pain, constipation and food intolerances
5. Was prescribed Buscopan Forte for 3 weeks
6. Felt my lower abdomen slide down/drop while straining hard and stuff came out of my anus which looked like a partial prolapse. From then on, stuff always came out of my anus whenever I was straining.
7. Few days later, all of my symptoms worsened significantly and I started getting tenesmus and mucous without stool
8. After drinking sip of soda, my lower abdomen inflated so painfully that I thought it was going to pop
9 Diagnosed with Impacted colon after an X-ray and was prescribed stimulant laxatives for 5 months
10. Changed to a different doctor who prescribed me a Nexium and Psyllilum for my gastritis
11. My symtoms gradually lessened after several months of Nexium and Psyllium
12. My symptoms went from severe to moderate but it stopped getting better after that
13. Had a CT Scan because they thought I had Sigmoid Vulvulus during a Colonoscopy
14. CT Scan showed no structural problem so I was diagnosed with IBS-C and Slow Transit by a gastroenterologist

ENDOSCOPY REPORT said...


Findings:
Digital rectal examination: No masses felt.
Colonoscope advanced to the: Caecum. Bowel preparation good with adequate mucosal views throughout. There was an unual twist in the colonic mucosa in the area of the mid-sigmoid which made it difficult to pass the colonoscope. It had the appearance of a partial sigmoid volvulus. Allowing for this, after passage past this point, passage of the colonoscope was not problematic. I detected poor bowel tone with a degree of "floppinesss" of the colon. This could explain recent constipation arising from slow colonic transit. Rectal and colonic mucosa appeared normal throughout. This suggests that the twist in the sigmoid may arise from an extrinsic source. Random colonic biopsies taken. No polyps or malignant appearing lesions seen. No evidence of mucosal ulceration or inflammation.
Withdraw time: 10 min.

Conclusion:
1. Unual twist in mid-sigmoid colon, but otherwise colonic mucosa appeared normal throughout. Await biopsies.

Plan:
1. Post recovery consultation performed.
2. If a CT scan has not been performed, suggest this be done prior to my review.

CT Abdomen said...


Clinical Information: Worsening constipation. Unusual twist in the sigmoid colon reminiscent of a Volvulus/extrinsic compression? Extra colonic mass or compression in abdomen. No previous films however are available for comparison.

Technique: Post contrast axial scans obtained through the abdomen and pelvis.

Findings: No focal abnormality identified in the liver or spleen. The kidneys are concentrating contrast normally, no evidence of obstruction. Pancreas is normal. Gallbladder is well distended. No para-aortic lymphadenopathy. There is a relatively homogeneous density in the pelvis above the urinary bladder presumed to be bowel but it is difficult to assess due to the absence of intra mesenteric fat. No evidence of bowel obstruction. No free fluid in the abdomen or pelvis. No para-aortic lymphadenopathy. Bones are normal.

Conclusion: No definite intra-abdominal pathology can be identified to account for patient's symptoms. In particular no evidence of colonic volvulus or obstruction.

Specimen: RANDOM COLOIC BIOPIES said...


Macroscopic: (JM/PC)

The specimen consists of multiple mucosal biopsies ranging in size from 2 to 6mm. All embedded.

Microscopic:

The sections show fragments of colonic mucosa which show a few neutrophils focally in the lamina propria.
Three scattered lymphoid aggregates are also present in the lamina propria.
The other cellular components of the lamina propria are normal.
The surface and crypt morphologies are normal with a normal goblet cell population.
There is no deposition of collagen in the subepithelial stroma nor an increase in intraepithelial lymphocytes.
Parasties, ova and cysts are not found.
There is no evidence of inflammation or neoplasia

SUMMARY: BIOPSY, RANDOM COLON
MINOR MUCOSAL INFLAMMATION POSSIBLY REPRESENTING A RESOLVING SELF-LIMITING COLITIS.
However, correlation with clinical and colonoscopic findings is essential.

1. No bowel movement for up to 3 days or more(even with psyllium) unless I take laxatives/coffee
2. Have all kinds of food intolerances which causes me to visit the toilet multiple times a day with my tenesmus and mucous w/ stool if I eat them.
3. Stuff comes out of my anus when I strain which looks like a partial rectal prolapse(Possibly missed during a colonoscopy).
4. Lacking in energy and difficulty concentrating possibly because of the above.
5. Have trouble exercising because of constipation.
6. When I'm bloated, my right lower abdomen is more inflated than my left lower abdomen which makes my stomach look unsymmetrical. Even when I'm not bloated, my stomach tone doesn't look symmetrical particularly after I eat.

1. Green tea causes tenesmus, mucous without stool and rectal bleeding.
2. Black coffee causes tenesmus and mucous without stool. And I get less of these symptoms if I mix it with milk.
3. Lactose-free Yogurt causes rectal bleeding which is only visible after I wipe with a toilet paper and I don't think it's from haemorrhoids.

Post Edited (Heinstein) : 2/11/2013 4:32:21 AM (GMT-7)

GastroGeorgieGirl said...
Dear Heinstein:
You are not alone. I recently was diagnosed with Slow Transit Constiaption after taking the Sitz Marker Test. I also have Annorectal Dyssynergia and have suffered for decades after an array of IBS symptoms. The Sitz Marker was a rather easy test to take. While our case is different in many ways, there are threads of similarities. I, too, have many fears about my situation and simply need a support forum to help me through my fears.