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PubMed2000

[Toxic megacolon].

Toxic megacolon is a serious complication of inflammatory bowel disease, thus its prevention should be performed thoroughly. In patients with severe colitis refractory to maximal oral and topical therapy or who presents with toxicity, intravenous steroids are obligatory. If there is failure to achieve significant improvement within 7-10 days colectomy or treatment with intravenous cyclosporine or azathioprine are mandatory. In addition to maximal medical therapy as for severe colitis including broad spectrum antibiotics, patients with toxic megacolon should be kept nil per os, with small bowel decompression tube (if a small bowel ileus is present) and rotated into the prone or knee-elbow position frequently (evacuation of bowel gas). Any clinical, laboratory, or radiological deterioration require immediate colectomy. The duration of medical treatment of megacolon is controversial if no significant improvement is noted. Some experts support surgery within 72 hours, others take a more observing position if no toxic symptoms are present, but some advocate surgery within 24 hours.

Humans↗
PubMed1975

[Behcet's disease and toxic megacolon].

The gastrointestinal symptoms of Behçet's disease are ancillary manifestations of this disorder reflected principally in the form of diarrhea, abdominal pain, meteorism, nausea, and loss of appetite. If radiological changes can be detected they generally appear as dilatation of the small intestine or ulceration at different levels of the digestive tract. In our patient the intestinal symptoms started with dilation of the ileum and then toxic megacolon developed. At later follow-up examinations the radiological picture resembled Crohn's disease and ischemic colitis of the entire organ. It has been repeatedly, and wrongly, stated that there is an association between Behçet's disease and Crohn's disease or ulcerative colitis. Rather, it should be assumed that the intestinal manifestations of Behçet's disease correspond to those of Crohn's disease and ulcerative colitis without these diseases being actually present. The evolution towards toxic megacolon may be the consequence of a transmural infection across the colonic wall deriving from the mucosal ulcerations of colon and sigmoid, and proves that toxic megacolon is not a pecific complication of ulcerative colitis but may appear in the course of any acute inflammatory ulcerative lesion of the colonic wall.

Adrenal Cortex Hormones↗
PubMed2002

Risperidone and megacolon.

Risperidone is an atypical anti-psychotic medication with both 5HT2 receptor and D2 dopamine receptor antagonism. Its use has been reported to be generally safe with very few gastro-intestinal (GI) adverse or side effects. In this paper, we describe a case of megacolon associated with the use of risperidone. A 44-year-old man suffering from schizophrenia was treated with risperidone and developed gross abdominal distension after twenty-five days. Abdominal X-ray and colonoscopy showed megacolon. He improved following a surgical decompression and a reduction of risperidone dosage. We discuss the neuro-electro-physiological mechanisms of gastro-intestinal motility and conclude that the risperidone-associated megacolon may be dose-related and that there should be a heightened awareness of such possible GI complication when using risperidone.

Adult↗
PubMed1999

Subtotal colectomy and ileocolonic anastomosis in a Vietnamese pot-bellied pig with idiopathic megacolon.

A 7-month-old sexually intact female Vietnamese pot-bellied pig was evaluated because of constipation. On abdominal palpation, a hard tubular structure was palpated in the middle of the abdomen. Abdominal radiography revealed loops of intestine that were markedly distended with ingesta, consistent with obstructive intestinal disease. On exploratory celiotomy, a massively distended cecum and spiral colon were found. A subtotal colectomy, with a side-to-side ileocolonic anastomosis, was performed. The cause of the megacolon was not discovered. The pig did well following surgery and eventually defecated normally following an initial period of diarrhea. To our knowledge, this is the first report of therapeutic removal of a substantial portion of the large intestine in swine. Our decisions concerning the pig of this report were based largely on our knowledge of megacolon in cats. The outcome for this pig indicates that subtotal colectomy along with removal of the cecum and ileocecal valve can be used to successfully treat idiopathic megacolon in Vietnamese pot-bellied pigs.

Anastomosis, Surgical↗
PubMed2004

[Megacolon imitating emphysema in the course of diaphragmatic hernia].

A 61-year old man with fever, diarrhoea, weight loss has been admitted to the hospital. Nine years earlier an air bubble in the lower part of the left lung was recognised during the chest x-ray, four years later diagnostic studies have shown a megacolon situated in the chest that significantly pressed on the flesh of the left lung and shifted the mediastinum to the right side. At that time the patient did not agree for an operation treatment. He decided for surgery in May 2002. During the operation the presence of an enormous large intestine of the megacolon type has been determined which could be found there due to diaphragm loss. The megacolon and spleen were surgically removed and the injured diaphragm was sutured. After 2 years a clinical and functional examinations of the respiratory system were performed. There was an improvement of the exercise capacity, recession of restriction in functional examinations and an increase in body mass.

Diagnosis, Differential↗
PubMed1991

Partial colectomy for treating acquired megacolon in long-tailed macaques.

A syndrome presenting as gross abdominal distension and diagnosed as acquired megacolon was observed in five adult female long-tailed macaques. Gastrointestinal signs included diarrhea, mucus in the stool, anorexia, and failure to pass stool, with repeated episodes of extreme abdominal distension and accumulation of gas and feces in greatly enlarged colons. Medical management was unsuccessful. A partial colectomy with a standard end-to-end colonic anastomosis was performed to remove the section of distended colon in each animal. Histologically, affected colons had degeneration and fibrosis, primarily in the longitudinal layer of the lamina muscularis. Hemograms, serum chemistries, and histopathologic features were not diagnostic of a specific etiology for megacolon. Four of five animals had undergone at least one obstetrical surgery. Two of these had the first episode of colonic distension within 3 days postoperatively. Intra-abdominal adhesions were noted during exploratory surgery in all animals. Three of five had colonic volvulus observed during colectomy. Recovery post-colectomy was uneventful and animals remained free of clinical signs of megacolon.

Animals↗
PubMed1977

[Adrenergic receptors in the pathogenesis of congenital megacolon (author's transl)].

Contractions of fresh specimens of taenial musculature from human colon were investigated under the influence of depolarization (bathing in solutions high in potassium), of acetylcholine, and of adrenaline; definite changes of contractile tension could be induced by these agents. The investigations were carried out using normal musculature as well as specimens from patients with congenital megacolon taken from the narrow segment. Contractions after depolarization and after cholinergic stimulation were equal in all specimens investigated, pre-extension of these specimens not differing significantly. Relaxation of colon musculature mediated by adrenergic receptors was very pronounced in normal musculature, but was lacking in specimens taken from the narrow segments of congenital megacolon. Sympathetic stimulation of normal taenial musculature does abolish completely cholinergically induced contractions. On the other hand, a preparation relaxed by adrenaline contracts very little after additional application of acetylcholine. These findings do suggest a severe disturbance of adrenergic receptors in the colon, or of adrenergic neuromuscular transmission in congenital megacolon.

Humans↗
PubMedDate not supplied

[Toxic megacolon: physiopathologic mechanism and surgical choices].

Toxic megacolon is the most dreadful complication arising in patients affected with inflammatory bowel diseases. Its incidence is rather rare, bur mortality rate is significantly high (about 40% of cases). Pathological modifications occurring in toxic megacolon deeply influence evolution and prognosis of this complication and, consequently, surgical choices. Starting from the pathophysiology of toxic megacolon, the Authors review their experience with acute colitis, emphasizing the need for a radical treatment, as only total colectomy can assure, versus Turnbull's operation or more decompression of the bowel. To save the colon means, in fact, to leave the source of sepsis "in situ". The authors experienced Turnbull's procedure only in one of the patients observed with "quoad vitam" poor results.

Colitis, Ulcerative↗
PubMed1989

[Functional megacolon in children].

The author discusses a group of 21 children (15 boys and % girls aged between 4 and 16 years) with diagnosed syndrome of the functional megacolon. Possible causes of the chronic constipation which could lead to the functional megacolon have been analysed. The treatment--preceded by the detailed analysis of anamnesis and laboratory tests (rectoscopy and contrast medium enema)--included: enemas washing out the colon, emollient and laxative agents, fiber-rich diet, and instructions on the proper defecation. Excellent therapeutical results seem to result from the detailed explanation of causes of the functional megacolon. It has enabled to avoid surgical treatment which should be carried out in these cases in which long-term conservative treatment failed.

Adolescent↗
PubMed1988

Absence of diarrhea in toxic megacolon complicating Clostridium difficile pseudomembranous colitis.

We describe a patient with Clostridium difficile-associated pseudomembranous colitis who presented with toxic megacolon without diarrhea. The discussion includes a brief review of the literature, and suggests an important role for endoscopy in the diagnosis of pseudomembranous colitis and, possibly, as part of the therapy for toxic megacolon associated with Clostridium difficile colitis. The unusual combination of toxic megacolon without antecedent diarrhea should be recognized as a possible manifestation of antibiotic-associated pseudomembranous colitis, especially in the setting of simultaneous antimicrobial and opiate administration. Early diagnosis and disease-specific intervention can be lifesaving.

Aged↗
PubMed1986

Subtotal colectomy for treatment of acquired megacolon in the dog and cat.

The case records of 4 cats and 1 dog with megacolon and constipation were reviewed to study the history, clinical signs, pathologic changes, and longterm results of surgical treatment. The 4 cats had idiopathic megacolon. The dog had megacolon secondary to dietary indiscretion. All animals had radiographic evidence of a large colon, which was confirmed by exploratory coeliotomy. Two of the cats and the dog had an intraoperative finding of megacecum as well. Subtotal colectomy was performed in all cases, with the ileocolic valve being removed in 3 of these cases. End-to-side anastomosis was used to restore the integrity of the bowel. All animals were treated successfully with this surgical technique, as judged by clinical response and owner satisfaction. Histologically, there were no consistent lesions to explain the cause of this disease in the cats.

Animals↗
PubMed1972

Ultrastructural and histochemical studies of murine megacolon.

The myenteric plexus of the colon was studied ultrastructurally in a colony of an Ls Ls strain of mice manifesting a piebald coat color mutation associated with a high incidence of genetically determined aganglionic megacolon. Ultrastructural studies were histochemically supplemented by the Maillet technic and stains for acetylcholinesterase and catecholamines. The development of megacolon did not appear to require total aganglionosis, since ostensibly aganglionic areas contained rare ganglion cells. In the distal narrowed segment, both cholinergic and adrenergic fibers in the muscularis, submucosa and mucosa were somewhat reduced. In the mouse, the dilated portion showed an abrupt increase in adrenergic fibers. These findings are related to the pathophysiology of the disorder. The increasing degenerative changes seen in myenteric plexus structures from the fetus to adult suggest that aganglionic megacolon may be an abiotrophy, wherein the congenitally deficient myenteric plexus may be unusually predisposed to postnatal injury and degeneration.

Acetylcholinesterase↗
PubMed1982

[Idiopathic megacolon (author's transl)].

The diagnosis of congenital megacolon can only rarely be established in adult cases with dilatation of the rectum and sigma, since the narrow aganglionic segment and increased levels of plasma acetylcholinesterase activity are usually lacking in adult cases,--these findings being typical for congenital megacolon. Idiopathic megacolon thus is the correct diagnosis in most of these adult cases. Surgical removal of the dilated parts of the intestine and end-to-end anastomosis yield satisfactory results, thus a colostomy is not necessary.

Adult↗
PubMed1981

Colonic gas distribution in toxic megacolon.

To determine whether dilation of the transverse colon is a specific pathophysiologic feature in toxic megacolon, plain films of the abdomen in different positions were obtained of 6 patients with ulcerative colitis complicated by toxic megacolon. All patients were examined initially in the supine position and subsequently in the prone position. Redistribution of gas in the colon occurred in all patients when the prone position was assumed. The shift of gas was largely from the transverse colon to the descending colon. Pathological examination of the colon in 5 patients revealed the transverse colon to be no more severely involved than the remainder of the colon. The findings suggest that distribution of colonic gas in toxic megacolon is largely governed by the influence of gravity and the anatomic position of the colon in the peritoneal cavity.

Adult↗
PubMedDate not supplied

[Miguel Dias Pimenta (1661-1715) and the history of chagasic megaesophagus and megacolon].

In the present study an attempt was made to analyse from a clinical viewpoint the descriptions in the book "Noticias do que he o achaque do bicho" by Miguel Dias Pimenta (1661-1715), which are considered by some authors to be the first reference to the chagasic megaesophagus and megacolon that appeared in history. In descriptions considered to refer megaesophagus, although dysphagia, the major symptom of this disease, is not recognized, typical manifestations of a irritating, inflammatory or ulcerative condition are identified, not affecting the esophagus but the stomach. In the description considered to refer to megacolon, the signs and symptoms suggest the diagnostic possibility of hemorrhoids and of the "achaque do bicho" itself, and do not recall the clinical picture of the chagasic megacolon in an absolute manner. On this basis, there is no reason to maintain the book "Noticias do que he o achaque do bicho" within the history of the digestive form of Chagas' disease.

Chagas Disease↗
PubMed1977

Surgical management of toxic megacolon.

Toxic megacolon developed in ten of 220 patients (4.5%) admitted for chronic ulcerative colitis over the past 11 years. Nine of these patients came under the care of the Surgical Department. Only three of these 10 patients had previously been treated with steroids. Steroid therapy reversed the acute process in three patients (33%). All three patients later came to surgery. Toxic megacolon developed during the first episode of ulcerative colitis in seven of ten patients (70%). Three of the seven (43%) had perforated their colons prior to operation. Two patients died after a subtotal colectomy and one without operation. A delayed diagnosis was associated with sepsis in five patients (50%) and with all three deaths. Seven patients survived proctocolectomy. Prolonged medical management without dramatic response appeared to correlate with a high postoperative morbidity. This study supports the concept of aggressive diagnosis and early surgical intervention for toxic megacolon.

Acute Disease↗
PubMed1956

Congenital aganglionic megacolon.

Twenty-one pull-through procedures for congenital aganglionic megacolon (Hirschsprung's disease) have been performed at the Los Angeles Children's Hospital since the adoption of the etiological concept of a distal aganglionic segment in 1949. In 14 cases the Swenson procedure as modified by Hiatt was employed, with perineal excision of the colon segment. There were four postoperative deaths and three symptomatic recurrences in this group. Three patients were treated by transabdominal resection of colon and rectum with subsequent pull-through reconstruction (Swenson). Anterior resection (State) was carried out in two cases. Three children with recurrence of symptoms following primary operation were subjected to a secondary pull-through procedure with an eventual successful outcome. The major portion of the postoperative mortality (29 per cent) in this group occurred in infants less than six months of age in whom anastomotic disruption or proximal segment infarction occurred after operation.A study of 31 cases of congenital aganglionic megacolon in very young infants drew attention to the difficulty of establishing a diagnosis in this age group even at exploratory laparotomy. Among these infants the mortality rate was excessive, regardless of the form of therapy employed. Colostomy appeared to be the indicated surgical procedure if a conservative regimen failed to control intractable colonic obstruction during the first year of life.

Child↗
PubMed1991

Results of the Duhamel operation in the treatment of idiopathic megarectum and megacolon.

The results of the Duhamel operation in patients with idiopathic megarectum and megacolon have been reviewed. Twenty patients (14 males, six females) underwent the Duhamel operation over a 17-year period for this condition. The mean age at operation was 25 years; the mean age of onset of constipation was 3 years; and the mean follow-up period was 4.5 years. All the resected colons were of enlarged diameter. There was agreement between the preoperative radiographs and the operative specimens with regard to which parts of the rectum and colon were dilated. Subjective feelings of well-being were generally improved by surgery, as was bowel frequency in ten patients. Soiling, straining, abdominal pain and distension were, however, common after operation. Early complications were also common and five patients required further surgery for constipation. The Duhamel operation for megarectum and megacolon is characterized by an improved sense of well-being and improved bowel frequency, but it is associated with the persistence of many symptoms and further surgery is often required.

Adolescent↗