Rosalind Franklin University of Medicine and Science McHenry, IL, United States
Shirly S. Samuel, MD1, Artem Sharko, MD1, Arvin J. Mallari, MD1, Nicole Gentile, MD2 1Rosalind Franklin University of Medicine and Science, McHenry, IL; 2GI Partners of Illinois, McHenry, IL
Introduction: We present a rare case of a young man with abdominal pain and malaise with CT finding of massively dilated colon, with further work-up negative for other causes such as Hirschsprung's leading to the diagnosis of chronic constipation causing megacolon.
Case Description/Methods: A 20-year-old male with past medical history of chronic constipation, craniofacial dystosis presented with generalized abdominal pain, bloating, and feeling of malaise. Patient had recurrent episodes of fecal impaction and encopresis as a child. He had a negative sweat chloride test and anorectal manometry in the past. Patient stated that he had been using polyethylene glycol intermittently at home. He was unable to take any oral intake and had one episode of vomiting prior to presentation. Physical exam revealed a diffusely tender, distended abdomen with a digital rectal exam pertinent for hard stool in the rectal vault. CT abdomen showed a massively distended and fluid filled colon, up to 14.2 cm in diameter, extending from the distal transverse colon to the rectum. He subsequently underwent disimpaction under anesthesia and an anorectal biopsy which revealed intact ganglion cells, thus ruling out Hirschsprung's disease. Patient was also started on a bowel regimen with polyethylene glycol and reported improvement in symptoms.
Discussion: This is a rare case of megacolon secondary to chronic constipation in a young male. One of the top differential diagnosis was Hirschsprung's disease which is characterized by aganglionic colon, and in some cases can present as chronic constipation later on in childhood. Hirschsprung’s disease is also associated with congenital abnormalities such as dysmorphic features which our patient had. The diagnosis is finalized through rectal biopsy with the definitive treatment being surgery . However, in our case, the rectal biopsy was negative. Chronic constipation has multifactorial etiology including lifestyle and colonic structural anomalies and can be associated with idiopathic megacolon. This is commonly seen in women than men and increasingly after the age of 65 years . While chronic constipation is a common complaint with a 15% worldwide prevalence, it can present as megacolon with associated risk of perforation . In young patients with recurrent episodes of constipation with fecal impaction, it is important to rule out congenital disorders. Regular bowel regimen including fiber supplementation and laxatives should be prescribed for patients with chronic constipation.
Figure: Massively distended and fluid-filled rectum and sigmoid
Shirly Samuel indicated no relevant financial relationships.
Artem Sharko indicated no relevant financial relationships.
Arvin Mallari indicated no relevant financial relationships.
Nicole Gentile indicated no relevant financial relationships.
Shirly S. Samuel, MD1, Artem Sharko, MD1, Arvin J. Mallari, MD1, Nicole Gentile, MD2. P1239 - Massively Dilated Colon in a 20-Year-Old Male, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.