The patient was a male with a history of schizophrenia, living alone, unmarried and without children. He has been living in a psychiatric hospital for a long time and is on oral antipsychotic medication. He often has difficulty having a bowel movement, which occurs once every 5-7 days, and each bowel movement needs to be assisted by the application of a cork or oral laxative.
In the last 5 days, the patient presented with abdominal distension and pain, nausea and vomiting. On closer examination of the medical history, there was no bowel movement for half a month. On examination, the abdomen was markedly distended, and intestinal shapes and peristaltic waves were visible. The whole abdomen was soft with scattered pressure pain, and the left lower abdomen could be palpated with salami-like material, which was hard and smooth with obvious tenderness. Rectal finger examination did not reveal any obvious abnormality. The patient was given a fasting diet, gastrointestinal decompression, oral paraffin oil and Fosamax bulking agent, and an enema. The patient eliminated more dry stools, and the abdominal pain and distension were significantly relieved. During hospitalization, the patient ate a lot and then repeatedly had difficulty in defecation and other conditions, and the effect of treatment such as oral medication and enema was not good.
Later, after communication with the family and guardian, a dissection was performed under general anesthesia. Intraoperatively, the whole colon was seen to be dilated, with a large amount of gas in the intestinal lumen and more dry fractions in the descending colon and sigmoid colon. The patient was considered to be suffering from slow colonic transmission and rim disease caused by long-term psychiatric drugs, and a large number of fecal masses were removed and a sigmoid colostomy was performed. After several discussions in the department and communication with the patient’s family and guardians, the diagnosis of the marginal disease was considered to be established.
Later, after careful preparation, total colectomy and low ileorectal anastomosis were performed again under general anesthesia, and the postoperative recovery was satisfactory, and the difficulty in defecation and abdominal pain and distension disappeared.