ABSTRACT
Idiopathic proximal hemimegacolon is a disorder characterized by bowel dilatation proximal to the splenic flexure. It is a very rare and therefore a poorly understood clinical entity. This report describes a case of idiopathic proximal hemimegacolon in a 44-year-old woman. The patient suffered from 2 episodes of constipation and bowel dilatation over 4 years and was successfully treated by medical therapy.
Subject(s)
Adult , Female , Humans , Colon, Transverse , Constipation , Dilatation , Medical FutilityABSTRACT
The etiology of several motility disorders, including persistent megacolon after definitive surgery for Hirschsprung's disease, meconium ileus which is not associated with cystic fibrosis and idiopathic megacolon, is still unclear. Interstitial cells of Cajal (ICC) are thought to modulate gut motility as gastrointestinal pace maker cells. The aim of this study was to evaluate the role of ICC in the bowel walls of the patients (n=15) who had variable motility disorders. The ICC were identified by immunohistochemical staining using an anti-C-Kit antibody and the results were compared with control specimens (n=2). The control group (G1) showed evenly distributed ICC in their bowel walls. The second group (G2, n=5) who had normal bowel movements after Duhamel procedures and the third group (G3, n=4) who had persistent megacolon after Duhamel procedures showed absent or scarcely distributed ICC in their aganglionic bowels. The ICC were identified by immunohistochemical staining using an anti-C-Kit antibody and the results were compared with control specimens (n=2). The control group (G1) showed evenly distributed ICC in their bowel walls. The second group (G2, n=5) who had normal bowel movements after Duhamel procedures and the third group (G3, n=4) who had persistent megacolon after Duhamel procedures showed absent or scarcely distributed ICC in their aganglionic bowels. Whereas ICC were evenly distributed in the ganglionic bowels of G2, they were not seen or scarecely distributed in the ganglionic bowels of G3. Two patients (G4) who suffered from idiopathic megacolon showed absence or decrease of ICC in spite of presence of ganglion cells in their colons. Four neonates (G5) who underwent ileostomy because of meconium obstruction showed absent or markedly decreased ICC in the colon at the time of ileostomy and the distribution of ICC was changed to a normal pattern at the time of ileostomy closure between 39-104 days of age and their bowelmotility were restored after that. The results suggest that lack of ICC caused reduce motility in the ganglionic colons and it may be responsible for the development of various motility disorders. Delayed maturity of ICC may also play a role in the meconium obstruction of neinates.
Subject(s)
Humans , Infant, Newborn , Colon , Cystic Fibrosis , Ganglion Cysts , Hirschsprung Disease , Ileostomy , Ileus , Interstitial Cells of Cajal , Meconium , MegacolonABSTRACT
The condition of an idiopathically dilated colon appears to be clinically heterogenous, very uncommon, and subsequently often poorly managed. Recently, one case of idiopathic megacolon presented by constipation was investigated. The patient was abruptly constipated 6 months prior to the hospital visit. The results of a barium enema and colonoscopy were nonspecific. On plain abdominal radiographs, the ascending and transverse colon were markedly dilated, and the descending colon was not visible. During the conservative management, which included laxative and prokinetic medication, the clinical symptoms and the colonic dilatations on plain radiographs were reduced, and discharged. After that however, repetitive admissions due to abdominal distension and constipation ensued, and therefore a total colectomy was performed in order to improve the patient's quality of life.
Subject(s)
Humans , Barium , Colectomy , Colon , Colon, Descending , Colon, Transverse , Colonoscopy , Constipation , Dilatation , Enema , Megacolon , Quality of LifeABSTRACT
The condition of an idiopathically dilated colon appears to be clinically heterogenous, very uncommon, and subsequently often poorly managed. Recently, one case of idiopathic megacolon presented by constipation was investigated. The patient was abruptly constipated 6 months prior to the hospital visit. The results of a barium enema and colonoscopy were nonspecific. On plain abdominal radiographs, the ascending and transverse colon were markedly dilated, and the descending colon was not visible. During the conservative management, which included laxative and prokinetic medication, the clinical symptoms and the colonic dilatations on plain radiographs were reduced, and discharged. After that however, repetitive admissions due to abdominal distension and constipation ensued, and therefore a total colectomy was performed in order to improve the patient's quality of life.
Subject(s)
Humans , Barium , Colectomy , Colon , Colon, Descending , Colon, Transverse , Colonoscopy , Constipation , Dilatation , Enema , Megacolon , Quality of LifeABSTRACT
Megacolon is an uncommon condition in which the bowel is persistently of increased diameter and it is always associated with long-standing constipation. Two main groups are recognized according to whether or not ganglia are present in the intermuscular plane of the rectal wall. Their complete absence, even along a short segment of rectum, denotes Hirschspurung's disease. If ganglia are present, the dilated bowel may be secondary to some predisposing factor such as a stricture, a congenital anorectal abnormality, a cauda equina lesion etc. In other instances, however, there may be no apparent organic reason as to why the bowel should be so dilated. This latter condition is termed "idiopathic megacolon". We report the case of one female patient with idiopathic megacolon. During medical treatment, she was complicated with a sigmoid volvulus, we performed subtotal colectomy and cecorectal anastomosis and she improved without any complication.