Toxic megacolon is a severe complication of Clostridium difficile (C.difficile) colitis.As the prevalence of C. difficile colitis increases and treatments become more refractory, clinicians will encounter more patient...Toxic megacolon is a severe complication of Clostridium difficile (C.difficile) colitis.As the prevalence of C. difficile colitis increases and treatments become more refractory, clinicians will encounter more patients with C. difficile associated toxic megacolon in the future. Here, we review a case of toxic megacolon secondary to C. difficile colitis and review the current literature on diagnosis and management. We identify both clinical and radiologic criteria for diagnosis and discuss both medical and surgical options for management. Ultimately, we recommend using the Jalen criteria in conjunction with daily abdominal radiographs to help establish the diagnosis of toxic megacolon and to make appropriate treatment recommendations. Aggressive medical management using supportive measures and antibiotics should remain the mainstay of treatment. Surgical intervention should be considered if the patient does not clinically improve within 2-3 d of initial treatment.展开更多
Hirschsprung＇s disease （HD） is a disorder associated with congenital malformation of the enteric nervous system with segmental aganglionosis. Prevailing therapy includes a resection of the affected part of the bowe...Hirschsprung＇s disease （HD） is a disorder associated with congenital malformation of the enteric nervous system with segmental aganglionosis. Prevailing therapy includes a resection of the affected part of the bowel, However, patients often do not obtain complete functional improvement after surgical treatment. We present the case of a 25-year-old woman who had surgical treatment of lid in early childhood. After that procedure she had clinical features of constipation for years in the end, passing of stool once a week, requiring laxatives and enemas. We diagnosed an incomplete resection of the aganglionic bowel via rectal biopsy and resected the remaining aganglionic segment. Two months after surgery the patient＇s bowel function improved to a frequency of 1-4 stools per day. We conclude that regular follow-up is required to identify lid patients with persistent alterations of bowel function after surgery. In patients presenting with constipation, recognition of a remaining aganglionic segment or other alterations of the enteric nervous system should be aimed at in an early stage. 2005 The WJG Press and Elsevier Inc. All rights reserved展开更多
BACKGROUND Colonic duplication refers to a spherical or tubular cavity which shows similar properties with the native colon and is attached to the mesenteric side of the alimentary tract.It is the rarest in alimentary...BACKGROUND Colonic duplication refers to a spherical or tubular cavity which shows similar properties with the native colon and is attached to the mesenteric side of the alimentary tract.It is the rarest in alimentary tract duplications.Based upon anatomic feature,colonic duplications can be classified as spherical(cystic)or tubular,with the latter being less common(approximately 20%).Symptoms of colonic duplication are dependent on the duplication site and extent,and patient age,etc.Usually,patients with colonic duplication manifest typical intestinal obstruction,potentially accompanied by recurrent dark or bright red bloody stool,varying degrees of anemia-related symptoms,and body wasting.CASE SUMMARY A young male patient was admitted to our hospital due to recurrent abdominal pain.No definite diagnosis was achieved by computed tomography(CT)or electronic colonoscopy,and the bowel preparation efficacy was suboptimal.Hirschsprung disease was suspected,and thus laparoscopic exploration was performed.An approximately 60-cm-long inverted duplicated colon with severe edema and dilation was identified.It originated from the mesenteric side of the transverse colon and ended in the terminal part of the descending colon with a blind end.The parallel native colon had a thickened colonic wall,became stiff,and was poor in peristalsis.The patient then underwent subtotal colectomy and was discharged 7 d after the surgery.From 3 mo post-surgery to date,the patient had regular bowel movement once daily and a steady increase in body weight.CONCLUSION Tubular colonic duplication is a rare type of alimentary tract duplication that can be detected by ultrasonography,CT,or magnetic resonance imaging based on the actual clinical situation.Surgical resection of aberrant colon(including the duplicated colonic segment and other potentially involved colonic segments)is the only approach to cure this medical condition.展开更多
BACKGROUND Cytomegalovirus(CMV) enterocolitis presenting in the form of pancolitis or involving the small and large intestines in an immunocompetent patient is rarely encountered, and CMV enterocolitis presenting with...BACKGROUND Cytomegalovirus(CMV) enterocolitis presenting in the form of pancolitis or involving the small and large intestines in an immunocompetent patient is rarely encountered, and CMV enterocolitis presenting with a serious complication, such as toxic megacolon, in an immunocompetent adult has only been reported on a few occasions.CASE SUMMARY We describe the case of a 70-year-old male with no history of inflammatory bowel disease or immunodeficiency who presented with toxic megacolon and subsequently developed massive hemorrhage as a complication of CMV ileopancolitis. The patient was referred to our institute for abdominal pain and distension. Abdominal X-ray showed marked dilatation of ileum and whole colon without air-fluid level, and sigmoidoscopy with biopsy failed to reveal any specific finding. After 7 d of conservative treatment, massive hematochezia developed, and he was diagnosed to have CMV enterocolitis by colonoscopy with biopsy. Although the diagnosis of CMV enterocolitis was delayed, the patient was treated successfully by repeat colonoscopic decompression and antiviral therapy with intravenous ganciclovir.CONCLUSION This report cautions that CMV-induced colitis should be considered as a possible differential diagnosis in a patient with intractable symptoms of enterocolitis or megacolon of unknown cause, even when the patient is nonimmunocompromised.展开更多
Dilatation of the colon and the rectum, which is not attributable to aganglionosis, is a rare finding and can be the result of intractable chronic constipation. We report a rare case of a 29-year-old male patient with...Dilatation of the colon and the rectum, which is not attributable to aganglionosis, is a rare finding and can be the result of intractable chronic constipation. We report a rare case of a 29-year-old male patient with impressive megacolon, in whom Hirschsprung's or Chagas disease was ruled out. In the present case, dilatation of the colon was most likely due to a behavioral disorder with habitual failure of defecation. Chronic stool retention led to a bizarre bulging of the large bowel with displacement of the other abdominal organs and severe occult blood loss. Because of two episodes of life-threatening gastrointestinal bleeding despite conventional treatment of constipation, a surgical approach for bowel restoration was necessary. Temporary loop ileostomy had to be performed for depressurization of the large bowel and the subsequent possibility for effective antegrade colonic lavage to remove impacted stools. Shortly after the operation, the patient was healthy and could easily manage the handling of the ileostomy. However, the course of the megacolon in this young adult cannot be predicted and the follow-up will have to reveal if regression of this extreme colonic distension with reestablishment of regular rectal perception will occur.展开更多
Fecalomas that need surgical management are uncommon. We report a rare case of giant fecaloma in a 22 years old female, with a history of constipation since childhood and an abdominal mass. Abdomen CT scan revealed a ...Fecalomas that need surgical management are uncommon. We report a rare case of giant fecaloma in a 22 years old female, with a history of constipation since childhood and an abdominal mass. Abdomen CT scan revealed a giant fecaloma filling sigmoid lumen without signs of ischemia or either complications. Laparotomy and fecaloma extraction trough colotomy was undertaken after failure of conservative measures and endoscopic removal attempt. Hirschsprung disease having been ruled out, sigmoidectomy was performed for idiopathic megacolon. Post operative course was uneventful with good functional outcomes.展开更多
Allied disorders of Hirschsprung diseases(ADHDs)have abnormal enteric ganglia and symptoms that are similar to congenital megacolon.The classification of ADHDs includes neuronal dysplasia,enteric gangliocytomatosis,is...Allied disorders of Hirschsprung diseases(ADHDs)have abnormal enteric ganglia and symptoms that are similar to congenital megacolon.The classification of ADHDs includes neuronal dysplasia,enteric gangliocytomatosis,isolated ganglion dysfunction,immature ganglion,and internal anal sphincter achalasia.The diagnosis,treatment and prognosis of ADHDs are distinct from congenital megacolon.This review summarizes the classification,epidemiology,pathogenesis,gene basis,pathology,diagnosis,treatment,and prognosis of ADHDs based on existing diagnostic criteria.展开更多
文摘Toxic megacolon is a severe complication of Clostridium difficile (C.difficile) colitis.As the prevalence of C. difficile colitis increases and treatments become more refractory, clinicians will encounter more patients with C. difficile associated toxic megacolon in the future. Here, we review a case of toxic megacolon secondary to C. difficile colitis and review the current literature on diagnosis and management. We identify both clinical and radiologic criteria for diagnosis and discuss both medical and surgical options for management. Ultimately, we recommend using the Jalen criteria in conjunction with daily abdominal radiographs to help establish the diagnosis of toxic megacolon and to make appropriate treatment recommendations. Aggressive medical management using supportive measures and antibiotics should remain the mainstay of treatment. Surgical intervention should be considered if the patient does not clinically improve within 2-3 d of initial treatment.
文摘Hirschsprung＇s disease （HD） is a disorder associated with congenital malformation of the enteric nervous system with segmental aganglionosis. Prevailing therapy includes a resection of the affected part of the bowel, However, patients often do not obtain complete functional improvement after surgical treatment. We present the case of a 25-year-old woman who had surgical treatment of lid in early childhood. After that procedure she had clinical features of constipation for years in the end, passing of stool once a week, requiring laxatives and enemas. We diagnosed an incomplete resection of the aganglionic bowel via rectal biopsy and resected the remaining aganglionic segment. Two months after surgery the patient＇s bowel function improved to a frequency of 1-4 stools per day. We conclude that regular follow-up is required to identify lid patients with persistent alterations of bowel function after surgery. In patients presenting with constipation, recognition of a remaining aganglionic segment or other alterations of the enteric nervous system should be aimed at in an early stage. 2005 The WJG Press and Elsevier Inc. All rights reserved
文摘BACKGROUND Colonic duplication refers to a spherical or tubular cavity which shows similar properties with the native colon and is attached to the mesenteric side of the alimentary tract.It is the rarest in alimentary tract duplications.Based upon anatomic feature,colonic duplications can be classified as spherical(cystic)or tubular,with the latter being less common(approximately 20%).Symptoms of colonic duplication are dependent on the duplication site and extent,and patient age,etc.Usually,patients with colonic duplication manifest typical intestinal obstruction,potentially accompanied by recurrent dark or bright red bloody stool,varying degrees of anemia-related symptoms,and body wasting.CASE SUMMARY A young male patient was admitted to our hospital due to recurrent abdominal pain.No definite diagnosis was achieved by computed tomography(CT)or electronic colonoscopy,and the bowel preparation efficacy was suboptimal.Hirschsprung disease was suspected,and thus laparoscopic exploration was performed.An approximately 60-cm-long inverted duplicated colon with severe edema and dilation was identified.It originated from the mesenteric side of the transverse colon and ended in the terminal part of the descending colon with a blind end.The parallel native colon had a thickened colonic wall,became stiff,and was poor in peristalsis.The patient then underwent subtotal colectomy and was discharged 7 d after the surgery.From 3 mo post-surgery to date,the patient had regular bowel movement once daily and a steady increase in body weight.CONCLUSION Tubular colonic duplication is a rare type of alimentary tract duplication that can be detected by ultrasonography,CT,or magnetic resonance imaging based on the actual clinical situation.Surgical resection of aberrant colon(including the duplicated colonic segment and other potentially involved colonic segments)is the only approach to cure this medical condition.
基金Supported by the 2019 Yeungnam University Research Grant
文摘BACKGROUND Cytomegalovirus(CMV) enterocolitis presenting in the form of pancolitis or involving the small and large intestines in an immunocompetent patient is rarely encountered, and CMV enterocolitis presenting with a serious complication, such as toxic megacolon, in an immunocompetent adult has only been reported on a few occasions.CASE SUMMARY We describe the case of a 70-year-old male with no history of inflammatory bowel disease or immunodeficiency who presented with toxic megacolon and subsequently developed massive hemorrhage as a complication of CMV ileopancolitis. The patient was referred to our institute for abdominal pain and distension. Abdominal X-ray showed marked dilatation of ileum and whole colon without air-fluid level, and sigmoidoscopy with biopsy failed to reveal any specific finding. After 7 d of conservative treatment, massive hematochezia developed, and he was diagnosed to have CMV enterocolitis by colonoscopy with biopsy. Although the diagnosis of CMV enterocolitis was delayed, the patient was treated successfully by repeat colonoscopic decompression and antiviral therapy with intravenous ganciclovir.CONCLUSION This report cautions that CMV-induced colitis should be considered as a possible differential diagnosis in a patient with intractable symptoms of enterocolitis or megacolon of unknown cause, even when the patient is nonimmunocompromised.
文摘Dilatation of the colon and the rectum, which is not attributable to aganglionosis, is a rare finding and can be the result of intractable chronic constipation. We report a rare case of a 29-year-old male patient with impressive megacolon, in whom Hirschsprung's or Chagas disease was ruled out. In the present case, dilatation of the colon was most likely due to a behavioral disorder with habitual failure of defecation. Chronic stool retention led to a bizarre bulging of the large bowel with displacement of the other abdominal organs and severe occult blood loss. Because of two episodes of life-threatening gastrointestinal bleeding despite conventional treatment of constipation, a surgical approach for bowel restoration was necessary. Temporary loop ileostomy had to be performed for depressurization of the large bowel and the subsequent possibility for effective antegrade colonic lavage to remove impacted stools. Shortly after the operation, the patient was healthy and could easily manage the handling of the ileostomy. However, the course of the megacolon in this young adult cannot be predicted and the follow-up will have to reveal if regression of this extreme colonic distension with reestablishment of regular rectal perception will occur.
文摘Fecalomas that need surgical management are uncommon. We report a rare case of giant fecaloma in a 22 years old female, with a history of constipation since childhood and an abdominal mass. Abdomen CT scan revealed a giant fecaloma filling sigmoid lumen without signs of ischemia or either complications. Laparotomy and fecaloma extraction trough colotomy was undertaken after failure of conservative measures and endoscopic removal attempt. Hirschsprung disease having been ruled out, sigmoidectomy was performed for idiopathic megacolon. Post operative course was uneventful with good functional outcomes.
文摘Allied disorders of Hirschsprung diseases(ADHDs)have abnormal enteric ganglia and symptoms that are similar to congenital megacolon.The classification of ADHDs includes neuronal dysplasia,enteric gangliocytomatosis,isolated ganglion dysfunction,immature ganglion,and internal anal sphincter achalasia.The diagnosis,treatment and prognosis of ADHDs are distinct from congenital megacolon.This review summarizes the classification,epidemiology,pathogenesis,gene basis,pathology,diagnosis,treatment,and prognosis of ADHDs based on existing diagnostic criteria.
