Chronic Megacolon Workup

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

Updated: Feb 28, 2010

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Laboratory Studies
Imaging Studies
Other Tests
Procedures
Histologic Findings
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Laboratory Studies

Laboratory studies are important to exclude other etiologies, including electrolyte abnormalities (eg, calcium, magnesium, phosphorus).

Thyroid function tests should also be performed.

Imaging Studies

Abdominal plain films are useful for initial screening and assessment of severity.

After plain films reveal the megacolon, water-soluble contrast enema may be helpful for a number of reasons, as follows^[9]:

Accurately assesses the size of the colon
Helps to differentiate the presence of megacolon, megarectum, or both
Helps to define the anatomy
Can be used therapeutically to evacuate the colon

Distinguishing a colonic inertia etiology from that of a functional outlet obstruction is probably best accomplished by colonic marker transit studies. Numerous ways to perform this test are available. Note the following:

One method is to instruct the patient to consume 30 g of dietary fiber daily and to stop using laxatives, enemas, and all other nonessential medications for at least 2 days prior to (as well as during) the test.
The patient swallows the markers, and abdominal plain films are obtained on days 1, 3, and 5.
Patients with colonic inertia tend to have markers distributed throughout the large bowel from cecum to rectum, while patients with outlet obstruction exhibit markers proceeding normally through the colon but accumulating in the rectum.

Other Tests

Anorectal manometry may help to distinguish congenital from acquired megacolon. The presence of a rectoanal inhibitory response means that there are intact ganglia, and the patient does not have Hirschsprung disease. If the inhibitory response is absent, a rectal biopsy is still needed to confirm the diagnosis of Hirschsprung disease.

Pudendal nerve latency testing may elucidate problems related to peristaltic movement, anatomical and/or mechanical problems with evacuation, and nerve-associated problems with defecation.

Procedures

Colonoscopy should be used to rule out an obstructive/mechanical cause of colonic dilatation.

Histologic Findings

Histology is helpful for determining the etiology of the condition. Although full-thickness biopsy is the criterion standard to establish a diagnosis of Hirschsprung disease, mucosal suction biopsy is adequate in most instances. The absence of ganglion cells is characteristic of Hirschsprung disease, and specific stains for acetylcholinesterase are used to highlight abnormal morphology. Other than Hirschsprung disease, however, the presence of ganglion cells does not specify one cause over another. For most cases, there is no indication for histology because Hirschsprung disease is not considered or excluded by normal manometric findings.

Proceed to Treatment & Management

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.

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