Sexual abuse: a strong predictor of outcomes after colectomy for slow-transit constipation.

摘要

PURPOSE: This study was designed to determine the impact of a history of sexual abuse on the outcomes of ileorectal anastomosis for slow-transit constipation. METHODS: All patients undergoing subtotal colectomy and ileorectal anastomosis for slow-transit constipation by a single surgeon at a university hospital from 1991 to 2006 were identified. Age, time since surgery, psychiatric diagnoses, number of previous operations, and "functional" disorders were collected. Patients were questioned about a history of anal and vaginal sexual abuse. Use of alternative healthcare practitioners and remote postoperative physician visits for abdominal symptoms were elicited. RESULTS: Fifteen patients met study criteria, and 13 came for assessment. All were women, all were highly satisfied with the results of their surgery, and all said they would request the procedure again. Median age was 38 (range, 29-58) years, and time to follow-up was 97 (range, 25-166) months. Eleven subjects (85%) reported a current psychiatric condition being treated with psychotropic medication. Eight (62%) reported a history of sexual abuse, and seven (88%) reported both anal and vaginal abuse. Patients with a history of sexual abuse had a total of 32 operations before colectomy and 30 functional diagnoses, compared with a total of 3 operations and 3 functional diagnoses in the nonabused group (P = 0.001 and P = 0.0002, respectively). Similarly, seven of eight abused patients (88%) sought additional medical care for abdominal complaints after this surgery, compared with none of five in the nonabused group (P = 0.005). CONCLUSION: A history of sexual abuse should be sought in patients with slow-transit constipation, because it is a strong predictor of more functional diagnoses, more precolectomy operations, and more postcolectomy medical care for abdominal complaints.