Clinical features of idiopathic megarectum and idiopathic megacolon.

Abstract

Background-Dilatation of the rectum and/or colon, in the absence of demonstrable organic disease, is an uncommon and poorly characterised condition. Aims-To characterise the clinical and diagnostic features, and response to treatment, of patients with idiopathic megarectum (IMR) and idiopathic megacolon (IMC). Methods-A retrospective review was undertaken of all patients operated on for these conditions over a 23 year period. In addition all patients treated over a three year period were prospectively studied by means of a questionnaire, contrast studies of the upper and lower intestine, spine Patients with intractable constipation can be divided into those who have a normal diameter gut and those who have gut dilatation. The latter include patients with Hirschsprung's disease, chronic idiopathic intestinal pseudoobstruction and idiopathic megacolon or megarectum. The last conditions of an idiopathically dilated colon and/or rectum appear to be clinically heterogenous, are very uncommon, and hence are often poorly managed.This study aimed to characterise these conditions clinically. A large series of patients was defined precisely from the clinical, operative, and pathological aspects, by retrospectively studying all patients who underwent surgery at one hospital for these conditions over a 23 year period. To establish the clinical spectrum of all patients with this condition, including outcome, and to evaluate them consistently, we have also prospectively studied all patients with idiopathic megarectum or megacolon referred to the same hospital over a three year period. MethodsIn both the retrospective and prospective part of this study patients were divided into those with idiopathic megarectum (including a variable degree of sigmoid colon dilatation), total rectal and colonic dilatation, or megacolon with a normal size rectum.' RETROSPECTIVE STUDY OF OPERATED PATIENTSThe notes of patients classified as having idiopathic megarectum or megacolon who had surgery between 1968 and 1991 were reviewed. Patients were included only if the gut

Preoperative Colonoscopic Derotation Is Beneficial in Acute Colonic Volvulus

“…The term ‘institutional colon’ has been coined to describe the condition. There is growing evidence that segmental colon resection may not prevent volvulus recurrence in patients with idiopathic or acquired megacolon [33, 34, 35]. An increasing number of reports describe true sigmoid volvulus recurrence after sigmoidectomy [33, 36, 37]as well as the recurrence of obstructive symptoms [38].…”

“…All reports exclude insufficient initial surgical resection of the redundant sigmoid as a reason for recurrence. Recurrences developed years or even decades after the primary operation and all patients concerned showed colonic dysmotility, mainly idiopathic megacolon or megarectum [35]. Megacolon-associated colonic volvulus should therefore be considered as a distinct entity requiring a different surgical approach.…”

A Novel Technique to Identify Patients with Megarectum

“…There are no data in the literature exploring the effect of age on rectal dimensions and, thus, the significance of this is unknown, although it is known that IMR may affect all ages. 1 The widest rectal diameter was measured as in previous studies, 27,28 although it is accepted that this may not reflect the true average diameter of the rectum, along its entire length. The most appropriate level at which to measure rectal diameter is not established.…”

Chronic constipation - the role of clinical assessment and colorectal physiologic tests to obtain an etiologic diagnosis

“…Most of these cases have been diagnosed as adult Hirchsprung's disease, in other studies (2,3) . However, only one of our five megacolon patients had this diagnosis confirmed by fullthickness rectal biopsy (Figure 3).…”