Chronic Megacolon Treatment & Management

Author: David M Manuel, MD; Chief Editor: Julian Katz, MD more...

Updated: Feb 28, 2010

What would you like to print?

Medical Care
Surgical Care
Consultations
Diet
Show All

Medical Care

In the absence of perforation, initial management is conservative. Some experts believe a role exists for as-needed fecal disimpaction and for evacuation by enemas and suppositories.

Pay close attention to exclusion of any underlying cause. If identified, correct electrolyte/metabolite abnormalities, and remove medications that may influence colonic motility (eg, narcotics, anticholinergic agents, calcium channel antagonists).

The use of biofeedback for a colonic inertia etiology for chronic megacolon is probably not effective, although successful treatment of functional outlet obstruction with biofeedback has been reported.

In patients requiring hospitalization, decompression using nasogastric tubes and rectal tubes may assist in treatment. When such tubes are used, anecdotal experience has demonstrated that frequent position changes for the patient may help to improve decompression.

If the dilatation persists or worsens, colonoscopic decompression can be attempted, with consideration of placement of a decompression tube, per rectum, to the right side of the colon. Unfortunately, following decompression, the dilatation usually recurs; therefore, decompression with colonoscopy must be carefully considered, as it is not without risk in an unprepared, dilated colon. Many gastroenterologists no longer consider placement of a drainage tube at the time of colonoscopy, as it nearly always becomes clogged with stool and rapidly ceases to function.

Beyond these options for the treatment of acute megacolon, the recommended regimen for chronic megacolon in a stable patient is as follows:

Empty the bowel (eg, osmotic laxatives, enemas, suppositories, cathartics, digital disimpaction).
Practice a bowel habit retraining program (eg, scheduled times for defecation, increased physical activity if possible).
Consume bulking agents/bowel agents.
Slowly alter/individualize the regimen.

Surgical Care

Surgical care is generally recommended if the dilatation is persisting or worsening after the above medical measures have been exhausted.

Megacolon operative options include total abdominal colectomy with ileorectal anastomosis, total proctocolectomy with ileostomy, and total proctocolectomy with ileoanal anastomosis, depending on the site of the colon affected.

Total abdominal colectomy with ileorectal anastomosis is the operation of choice of megacolon with normal-sized rectum.

Consultations

These problems require a multidisciplinary approach, including the primary care provider, a gastroenterologist, a nutritionist/dietitian, and possibly a surgeon.

Diet

Patients with acquired, nonacute megacolon should follow a high-fiber, high-fluid intake diet, which usually helps to decrease constipation. Some patients with severe constipation state that a high-fiber diet produces greater difficulty with bloating and constipation.

Proceed to Medication

Contributor Information and Disclosures

Author

David M Manuel, MD Fellow, Department of Internal Medicine, Section of Gastroenterology, Providence Hospital and Medical Center

David M 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 of Gastrointestinal Endoscopy, and Crohns and Colitis Foundation of America

Disclosure: Nothing to disclose.

Coauthor(s)

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

Disclosure: Nothing to disclose.

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, and Crohns and Colitis Foundation of America

Disclosure: Nothing to disclose.

Clifford Y Ko, MD MS, Professor, Department of Surgery, University of California at Los Angeles School of Medicine

Clifford Y Ko, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Colon and Rectal Surgeons, Association for Academic Surgery, California Medical Association, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Specialty Editor Board

Terence David Lewis, MBBS, FRACP, FRCPC, FACP Program Director, Internal Medicine Residency, & Assistant Chairman, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, Loma Linda University Medical Center

Terence David Lewis, MBBS, FRACP, FRCPC, FACP 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, and Sigma Xi

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Douglas M Heuman, MD, FACP, FACG, AGAF Chief of GI, Hepatology, and Nutrition at North Shore University Hospital/Long Island Jewish Medical Center; Professor, Department of Medicine, Hofstra North Shore-LIJ 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, and American Gastroenterological Association

Disclosure: Novartis Grant/research funds Other; Bayer Grant/research funds Other; Otsuka Grant/research funds None; Bristol Myers Squibb Grant/research funds Other; Scynexis None None; Salix Grant/research funds Other; MannKind Other

Alex J Mechaber, MD, FACP Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

Camilleri M. Acute and chronic pseudo-obstruction. In: Felman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8^th ed. Philadelphia, Pa: Saunders; 2007:2679-702.
Camilleri M. Dysmotility of the small intestine and colon. In: Yamada T, ed. Textbook of Gastroenterology. Vol 1. 4^th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003:1486-529.
Wallukat G, Munoz Saravia SG, Haberland A, et al. Distinct patterns of autoantibodies against G-protein-coupled receptors in Chagas' cardiomyopathy and megacolon. Their potential impact for early risk assessment in asymptomatic Chagas' patients. J Am Coll Cardiol. Feb 2 2010;55(5):463-8. [Medline].
Sanchez-Mejias A, Fernandez RM, Lopez-Alonso M, Antinolo G, Borrego S. New roles of EDNRB and EDN3 in the pathogenesis of Hirschsprung disease. Genet Med. Jan 2010;12(1):39-43. [Medline].
da Silveira AB, de Araujo FF, Freitas MA, et al. Characterization of the presence and distribution of Foxp3(+) cells in chagasic patients with and without megacolon. Hum Immunol. Jan 2009;70(1):65-7. [Medline].
da Silveira AB, Freitas MA, de Oliveira EC, et al. Glial fibrillary acidic protein and S-100 colocalization in the enteroglial cells in dilated and nondilated portions of colon from chagasic patients. Hum Pathol. Feb 2009;40(2):244-51. [Medline].
Ribeiro BM, Crema E, Rodrigues V Jr. Analysis of the cellular immune response in patients with the digestive and indeterminate forms of Chagas' disease. Hum Immunol. Aug 2008;69(8):484-9. [Medline].
Martucciello G. Hirschsprung's disease, one of the most difficult diagnoses in pediatric surgery: a review of the problems from clinical practice to the bench. Eur J Pediatr Surg. Jun 2008;18(3):140-9. [Medline].
Orno AK, Lovkvist H, Marsal K, von Steyern KV, Arnbjornsson E. Sonographic visualization of the rectoanal inhibitory reflex in children suspected of having Hirschsprung disease: a pilot study. J Ultrasound Med. Aug 2008;27(8):1165-9. [Medline].
Barnes PR, Lennard-Jones JE, Hawley PR, Todd IP. Hirschsprung's disease and idiopathic megacolon in adults and adolescents. Gut. May 1986;27(5):534-41. [Medline].
de Oliveira GM, de Melo Medeiros M, et al. Applicability of the use of charcoal for the evaluation of intestinal motility in a murine model of Trypanosoma cruzi infection. Parasitol Res. Mar 2008;102(4):747-50. [Medline].
Harari D, Minaker KL. Megacolon in patients with chronic spinal cord injury. Spinal Cord. Jun 2000;38(6):331-9. [Medline].
Krishnamurthy S, Heng Y, Schuffler MD. Chronic intestinal pseudo-obstruction in infants and children caused by diverse abnormalities of the myenteric plexus. Gastroenterology. May 1993;104(5):1398-408. [Medline].
Lane RH, Todd IP. Idiopathic megacolon: a review of 42 cases. Br J Surg. May 1977;64(5):307-10. [Medline].
Manoel-Caetano Fda S, Carareto CM, Borim AA, Miyazaki K, Silva AE. kDNA gene signatures of Trypanosoma cruzi in blood and oesophageal mucosa from chronic chagasic patients. Trans R Soc Trop Med Hyg. Nov 2008;102(11):1102-7. [Medline].
Metcalf AM, Phillips SF, Zinsmeister AR, et al. Simplified assessment of segmental colonic transit. Gastroenterology. Jan 1987;92(1):40-7. [Medline].
Miyamoto M, Egami K, Maeda S, et al. Hirschsprung's disease in adults: report of a case and review of the literature. J Nippon Med Sch. Apr 2005;72(2):113-20. [Medline].
Nicholls RJ, Kamm MA. Proctocolectomy with restorative ileoanal reservoir for severe idiopathic constipation. Report of two cases. Dis Colon Rectum. Dec 1988;31(12):968-9. [Medline].
Porter NH. Megacolon: A physiological study. Proc R Soc Med. 1961;54:1043.
Preston DM, Lennard-Jones JE, Thomas BM. Towards a radiologic definition of idiopathic megacolon. Gastrointest Radiol. 1985;10(2):167-9. [Medline].
Stabile G, Kamm MA, Hawley PR, Lennard-Jones JE. Colectomy for idiopathic megarectum and megacolon. Gut. Dec 1991;32(12):1538-40. [Medline].
Stryker SJ, Pemberton JH, Zinsmeister AR. Long-term results of ileostomy in older patients. Dis Colon Rectum. Nov 1985;28(11):844-6. [Medline].
Yadav AK, Mishra K, Mohta A, Agarwal S. Hirschsprung's disease: is there a relationship between mast cells and nerve fibers?. World J Gastroenterol. Mar 28 2009;15(12):1493-8. [Medline]. [Full Text].

View Table List

Read more about Chronic Megacolon on Medscape