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We present the case of a 65-year-old woman with chronic constipation for 10 years that did not improve through dietary or drug treatment, and so she underwent total colectomy with intracorporeal ileorectal anastomosis with transvaginal specimen extraction. The procedure is called Natural Orifice Specimen Extraction (NOSE) and is used in both benign and oncologic resections with excellent results. The case presented herein is the first surgery for treating colonic inertia utilizing this technique that has been performed in Panama. Constipation affects 2 to 34% of the patient population of the Western world. Colonic inertia is a syndrome characterized by chronic constipation due to slow colon transit that is refractory to drug treatment. In these cases, metabolic, pharmacologic, and organic causes are ruled out first. Only 9.9% of the patients with constipation diagnosed with colonic inertia that is refractory to medical treatment are surgical candidates, as was the case with our patient. The studies carried out were: colonoscopy with no pathologic findings, colon transit time that reported colonic inertia, and defecogram and manometry whose results were within normal limits. Total colectomy with ileorectal anastomosis is the best available therapeutic option. It is a complex procedure, but with the advent of laparoscopic surgery and its advantages in relation to the cosmetic effects, hospitalization, recovery, and complications, this type of procedure is being performed more often. With prior liquid diet and colon cleansing, the patient was placed in the lithotomy position and given general anesthesia. A 10 mm trocar was placed using the open Hasson technique and insufflation of the pneumoperitoneum was begun. A 10 mm camera with a 30◦ lens was introduced, and the rest of the trocars were placed under direct vision at the right and left quadrants and at the epigastrium. The distal ileum was sectioned with Endo-GIA and the colon was resected using the medial to lateral approach. The rectum was then sectioned with Endo-GIA at the level of the promontorium. Posterior colpotomy with cautery was performed and the specimen was extracted transvaginally (Fig. 1). The vaginal defect was closed with absorbable monofilament suture (Fig. 2), an anvil was placed at the distal end of the ileum and attached with 2-0 monofilament. A circular transrectal EEA25 stapler was introduced and the ileorectal anastomosis was stapled, with a negative pneumatic test. The patient passed gas and began a diet 48 h later. She was released with good progression on the third

Colectomía total con extracción transvaginal del espécimen por inercia colónica