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Acute Megacolon Clinical Presentation

  • Author: Roberto M Gamarra, MD; Chief Editor: BS Anand, MD  more...
 
Updated: Dec 09, 2014
 

History

The typical patient is an elderly person who is in the hospital, usually for an unrelated reason (eg, recovering postoperatively from surgery), and may or may not already be taking oral feeds.

Orthopedic surgery, cesarean delivery, and cardiovascular or lung surgery are surgeries that commonly predispose to acute megacolon.

Acute megacolon can occur on the medical wards as frequently as on the surgical wards (eg, in patients with unrelated problems, such as pneumonia, sepsis, myocardial infarction, or stroke).

Systemic diseases that affect the neuromuscular component of the GI tract, such as amyloidosis, may first present with an acute episode of pseudo-obstruction.

Not having a history of similar episodes of abdominal distension in the past is common.

Colic-type pain may be present, but the absence of this pain does not imply a less severe condition.

Patients often will experience nausea and vomiting as well as constipation and obstipation.

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Physical

Physical examination findings may include the following:

  • The vital signs can all be normal.
  • Depending on the duration of the megacolon and the fluid status, the patient may become tachycardic.
  • With distension of the abdomen pushing on the lungs, the patient also may develop tachypnea. In this regard, the lung fields may be decreased.
  • The abdominal examination generally reveals a distended abdomen, which may or may not be tense. Serial measurement of abdominal girth is routinely unreliable.
  • Bowel sounds vary from absent to diminished to high-pitched, mimicking mechanical obstruction.
  • Tympany invariably is present.
  • Digital rectal examination should generally be performed to exclude fecal impaction.
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Causes

Causes of acute megacolon include the following:

  • Electrolyte abnormality
  • Metabolic abnormality, including hypothyroidism and hyperparathyroidism
  • Certain medications, including anticholinergics, antidiarrheals, opiates, digitalis, and certain antipsychotic drugs
  • Inflammatory bowel disease, including ulcerative colitis and Crohn colitis
  • Infections, including Clostridium difficile (pseudomembranous colitis), Trypanosoma cruzi (Chagas disease), and Entamoeba histolytica (amebic dysentery).[3]

Note that in any setting, a mechanical cause (eg, a tumor) and a toxic cause (eg, acute ulcerative colitis) must be ruled out first because the treatments are very different for these conditions.

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Contributor Information and Disclosures
Author

Roberto M Gamarra, MD Consulting Gastroenterologist, Digestive Health Associates, PLC

Roberto M Gamarra, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Crohn's and Colitis Foundation of America

Disclosure: Nothing to disclose.

Coauthor(s)

Michael H Piper, MD Clinical Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Wayne State University School of Medicine; Consulting Staff, Digestive Health Associates, PLC

Michael H Piper, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American College of Physicians, Michigan State Medical Society

Disclosure: Nothing to disclose.

David Manuel, MD Affiliate Faculty, Department of Medicine, Loyola University Health System; Gastroenterologist, Digestive Health Center

David Manuel, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Crohn's and Colitis Foundation of America

Disclosure: Nothing to disclose.

Ross A Heil, DO Fellow, Department of Gastroenterology, St John Providence Health System

Ross A Heil, DO is a member of the following medical societies: American College of Osteopathic Internists, American Medical Association, American Osteopathic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Douglas M Heuman, MD, FACP, FACG, AGAF Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, American Gastroenterological Association

Disclosure: Received grant/research funds from Novartis for other; Received grant/research funds from Bayer for other; Received grant/research funds from Otsuka for none; Received grant/research funds from Bristol Myers Squibb for other; Received none from Scynexis for none; Received grant/research funds from Salix for other; Received grant/research funds from MannKind for other.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Terence David Lewis, MBBS, MBBS 

Terence David Lewis, MBBS, MBBS is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, California Medical Association, Royal College of Physicians and Surgeons of Canada, Sigma Xi

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the contributions of previous author, Clifford Y Ko, MD, MS, to the development and writing of this article.

References
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  3. Tan CB, Rajan D, Shah M, Ahmed S, Freedman L, Rizvon K, et al. Toxic megacolon from fulminant Clostridium difficile infection induced by topical silver sulphadiazine. BMJ Case Rep. 2012 Aug 8. 2012:[Medline].

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  8. Geller A, Petersen BT, Gostout CJ. Endoscopic decompression for acute colonic pseudo-obstruction. Gastrointest Endosc. 1996 Aug. 44(2):144-50. [Medline].

  9. Ponec RJ, Saunders MD, Kimmey MB. Neostigmine for the treatment of acute colonic pseudo-obstruction. N Engl J Med. 1999 Jul 15. 341(3):137-41. [Medline].

  10. Saunders MD, Kimmey MB. Colonic pseudo-obstruction: the dilated colon in the ICU. Semin Gastrointest Dis. 2003 Jan. 14(1):20-7. [Medline].

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