What’s Megacolon?

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Megacolon is a medical condition characterized by enlargement of the colon, which can be congenital or triggered by the presence of an infection or intestinal obstruction. Regardless of the cause, all presentations of this condition often induce similar symptoms. Treatment depends on the underlying cause and often involves intravenous fluids to prevent dehydration and corrective surgery to restore proper colon function.

Toxic megacolon is considered a life-threatening complication associated with the existence of an underlying intestinal condition. The presence of inflammation and infection contributes to the toxicity of the condition causing the large intestine to dilate. Symptomatic individuals may experience a variety of symptoms that may include abdominal discomfort, tenderness, and distention. Additional signs of toxicity may include an elevated heart rate, fever, and nausea, and in extreme cases, shock.

Congenital megacolon is an intestinal blockage due to impaired muscle movement within the intestines. Due to the lack of nerves within the intestines, intestinal contents accumulate, causing abdominal distension and bowel dysfunction. Often diagnosed in infancy, this condition causes newborns to develop constipation, abdominal distension, and vomiting. Additional symptoms may include absence of a first stool (merconium), jaundice, and watery diarrhea.

A primary intestinal obstruction can occur in the small or large intestine and can present as an acute or chronic condition. Frequently diagnosed in children and the elderly, this form of colon dilation is idiopathic in nature, meaning there is no known cause in the absence of inflammation or infection. Individuals with chronic conditions, such as cerebral palsy or other neurological disorders, or those who are bedridden usually have a higher risk of developing this condition. Those who become symptomatic with nontoxic forms of colon dilation may experience abdominal discomfort, nausea, and vomiting.

The diagnostic tests used to confirm the presence of colonic dilation vary. If abdominal distension is present, a physical examination and palpation of the affected area may be done. Any abnormalities discovered during a preliminary examination usually require further testing. If toxic megacolon is suspected, further testing may include doing an abdominal X-ray and blood tests to evaluate electrolyte levels and look for any markers suggestive of infection.

Infants suspected of having congenital megacolon may be given a barium enema and an abdominal x-ray to confirm the presence of bowel dysfunction. A rectal exam may determine the presence of impaired rectal muscle tone, which may contribute to symptoms. In some cases, anal manometry may also be performed to evaluate rectal pressure.
If intestinal obstruction is suspected, a barium test may be done to confirm the presence and location of the blockage. Before testing, an individual is given barium, either by mouth or by injection, who is then monitored with the use of X-rays to assess the condition and function of the upper gastrointestinal tract and related organs, including the intestines. An esophageal manometry can be done to evaluate the condition of the esophagus, and bowel function can be evaluated with a bowel radionuclide scan.

Treatment for the toxic condition has a multifaceted approach. To reverse the effects of the condition, intravenous fluids may be given to prevent dehydration, and if the colon has become perforated, a partial or complete excision of the colon, known as a colectomy, may be performed. Antibiotics may also be given to prevent the infection from spreading, which can lead to sepsis. Due to a significant risk of death, prompt and appropriate treatment for colonic dilation is essential. Complications associated with this condition can include colon perforation, sepsis, and shock.
Congenital megacolon often requires removal of the abdominal portion of the colon and rectum. The remaining colon tissue is used to function in place of the removed portion. Before surgery, the intestine is decompressed to relieve pressure and allow for easier manipulation of the organ. The procedure is often done during two separate surgeries, and both can be completed before the baby is one year old. Complications associated with this corrective surgery can include short bowel syndrome, bowel inflammation, and intestinal perforation.

Nontoxic colon dilation can also be treated with medications and surgery. A colonoscopy can be used to relieve the accumulated wind, and intravenous fluids can be given to prevent dehydration that can result from excessive nausea and vomiting. Additional treatment for this potentially recurring condition may include the use of nasogastric aspiration, which involves placing a nasogastric (NG) tube to decompress the intestines and implementing dietary changes. Individuals with this condition generally demonstrate improvement within days of treatment. Complications can include diarrhea, unintentional weight loss, and mineral and vitamin deficiencies.

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