Surgical treatment of Chagas megacolon. Critical analysis of outcome in operative methods

Abstract

PURPOSE: Surgical treatment of chagasic megacolon has suffered innumerable transformations over the years. Poor knowledge of the disease physiopathology is one of the reasons. METHODS: From January 1977 to December 2003, 430 patients were submitted to surgical treatment for chagasic megacolon. Of these procedures, 351 were elective and 79 emergency operations carried out at the University Hospital of Ribeirão Preto. Four elective operations, most frequently used, should be singled out: anterior rectosigmoidectomy (52.71%), left hemicolectomy (18.23%), Duhamel-Haddad operation(15.95%), and total colectomy (5.98%). From the 79 exploratory laparotomies performed on an emergency basis, 53 (67.09%) required intestinal resection. From the 430 patients operated upon, 268 (62.33%) progressed without recurrence of intestinal constipation, and 71 (15.51%) had a recurrence. RESULTS AND DISCUSSION: Based on the data collected, left hemicolectomy had the highest constipation recurrence rate compared to other operating procedures; anterior retosigmoidectomy had less complication episodes and a larger recurrence of intestinal constipation in comparison to the Duhamel-Haddad operation. Emergency operations, mainly for the treatment of volvulus and fecaloma, presented high morbidity and mortality and required extensive intestinal resections, stomas and reoperations.

The Chronic Gastrointestinal Manifestations of Chagas Disease

“…Alteration of the rectoanal inhibitory reflex in most of the chagasic patients with megacolon was demonstrated by several researchers and can be justified by the destruction of enteric motor innervations 6,11,19,20,22,24,25,68,70. The choice of surgical treatment appears to have the same indication as a solution for constipation in both chagasic and idiopathic megacolon 71,72…”

Lineage Analysis of Circulating Trypanosoma cruzi Parasites and Their Association with Clinical Forms of Chagas Disease in Bolivia

“…One hundred patients had megacolon as determined by barium enema X-ray examination (n = 45) or by the macroscopic observation at the surgical operation (n = 55) (50 men and 50 women, mean age 51.3 years, age range 17–89). Out of 189 barium enema examinees, 45 (23.8%) were diagnosed megacolon and 21 patients (46.7%) out of the 45 megacolon patients showed elongation of the sigmoid colon [43]. Out of 114 patients who had both ECG and barium enema X-ray examinations, 73 patients (64%) without any complications after the above mentioned examinations were deemed indeterminate cases (34 men and 39 women, mean age 42.3 years, age range 29–65) (Table 2).…”

Chagas disease in the differential diagnosis of megacolon

“…Treatment of megacolon secondary to CHD should be to prevent surgical complications. Conservative treatment is reserved for patients oligosymptomatic or with surgical contraindications (5). Most patients with CHD have some type of heart disease, so they tend to be high risk for surgery (6).…”

“…It is caused by Trypanosoma cruzi (1) that is transmitted by blood-sucking insects, blood transfusions or fetal transmission (1,2). The CHD has three phases: an acute (non-specific symptoms) (3), one asymptomatic (antibody positive) and a significant chronic cardiac disease (leading cause of death) (4) and formation of digestive megavisceras such as megaesophagus and megacolon (5). The diagnosis depends on the stage of the disease and treatment is applicable only in the acute phase.…”