Functional constipation refractory to medical management: The colon is the problem

•Treating refractory functional constipation requires a collaborative approach by surgeons and gastroenterologists.•The work-up should include a contrast enema, anorectal manometry for assessment of the sphincters, and a colonic motility evaluation.•Antegrade flushes are effective and colon resections can be avoided in most cases, regardless of underlying colonic dysmotility.