Symptoms and diagnostic criteria of acquired Megacolon - a systematic literature review

Abstract

Background: Acquired Megacolon (AMC) is a condition involving persistent dilatation and lengthening of the colon in the absence of organic disease. Diagnosis depends on subjective radiological, endoscopic or surgical findings in the context of a suggestive clinical presentation. This review sets out to investigate diagnostic criteria of AMC. Methods: The literature was searched using the databases -PubMed, Medline via OvidSP, ClinicalKey, Informit and the Cochrane Library. Primary studies, published in English, with more than three patients were critically appraised based on study design, methodology and sample size. Exclusion criteria were studies with the following features: post-operative; megarectum-predominant; paediatric; organic megacolon; non-human; and failure to exclude organic causes. Results: A review of 23 articles found constipation, abdominal pain, distension and gas distress were predominant symptoms. All ages and both sexes were affected, however, symptoms varied with age. Changes in anorectal manometry, histology and colonic transit are consistently reported. Studies involved varying patient numbers, demographics and data acquisition methods. Conclusions: Outcome data investigating the diagnosis of AMC must be interpreted in light of the limitations of the low-level evidence studies published to date. Proposed diagnostic criteria include: (1) the exclusion of organic disease; (2) a radiological sigmoid diameter of~10 cm; (3) and constipation, distension, abdominal pain and/or gas distress. A proportion of patients with AMC may be currently misdiagnosed as having functional gastrointestinal disorders. Our conclusions are inevitably tentative, but will hopefully stimulate further research on this enigmatic condition.

Characterization of gut contractility and microbiota in patients with severe chronic constipation

“…However, there are severe forms associated with slow transit that are refractory to medical treatment. Idiopathic megacolon and dolichocolon are rare conditions that affect men and women equally and are associated with a permanently enlarged diameter or/and redundant colon [ 5 , 15 ]. The pathogenesis of idiopathic megacolon is still unclear.…”

“…The pathogenesis of idiopathic megacolon is still unclear. Abnormalities of the enteric nervous system and alterations in the function of smooth muscle cells and connective tissue elements have been suggested to be involved in gut dysmotility [ 5 , 13 , 15 ]. Growing evidence indicates that intestinal microbiota may contribute to constipation and constipation-related symptoms [ 39 ].…”

Botulinum toxin in the treatment of intestinal pseudo-obstruction following a stroke

“…A differential diagnosis was performed to exclude malignant obstructing diseases or benign conditions such as sigmoid volvulus, diverticulitis or colonic ischaemia. Abdominal and pelvic CT with contrast revealed the persistence of a large faecal impaction located in the sigmoid colon and a massive dilatation from the caecum to the rectum, with transverse colon of up to approximately 75 mm [normal value: < 60 mm] [10], sigmoid colon of up to 100 mm [normal value: < 65 mm] [10] and rectal ampulla of up to 58 mm [normal value: < 40 mm] [10] (Fig. 1).…”

The Skiles Mummy: Care of a debilitated hunter-gatherer evidenced by coprolite studies and stable isotopic analysis of hair

“…SMM has a clear case of megacolon. In clinical settings, megacolon is diagnosed based on the physical characteristics observed of the bowel or colon, usually based on the dilation of the colon to a certain diameter, ranging from 6 to 10 cm or larger (Cuda et al, 2018). The average diameter found in SMM's large intestine is 6 cm.…”

“…However, whatever its etiology, megacolon is caused by the same impetus: the degeneration of the myenteric plexus, or the major nerve supply that controls motility in the gastrointestinal tract. Although the case of Mr. K provides us some information with the impact of megacolon, at this time there are not any studies assessing the impact of the pathology on quality of life (Cuda et al, 2018).…”