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Doctors are urging caution after a 24-year-old UK man underwent emergency surgery when they discovered that his severely enlarged colon, filled with feces, had burst.
At the time of the surgery, the man had “reduced consciousness” and severe abdominal pain, as well as air trapped under his diaphragm, failing kidneys, and acidic blood.
In a short communication published this week in BMJ Case Reports, doctors elaborated on the man’s rare conditions, known as “megacolon” and “megarectum.” These are poorly understood ailments marked by enlarged entrails that aren’t caused by a physical blockage. Sometimes they can be explained by genetic abnormalities or other acquired conditions, such as diseases that affect intestinal motility or muscle and connective-tissue function. But in this case, the man seemed to have a chronic, idiopathic case, meaning there was no clear cause of the gargantuan guts.
Typically, the diameter of a healthy adult’s rectum and sigmoid colon (the S-shaped region of the colon closest to the rectum) is in the range of five to six centimeters or so. This man’s innards, however, had reached up to 18 centimeters at some points—and they were packed with poop.
- Sagittal view of the sigmoid colon filled with feces.
- Sagittal view of sigmoid colon post-perforation, with free air in the abdomen.
- Transverse view of sigmoid colon post-perforation, with free air and feces in the abdomen.
He had a long history of constipation and had shown up at an emergency department two days before doctors discovered his colon had ruptured. He had come in complaining of abdominal pain and diarrhea. His stomach was bloated, tender, and emitting “quiet bowel sounds,” the doctors noted. They sent him home with a plan to use laxatives and enemas. But that turned out to be too little, too late. Days later, his pain and symptoms had gotten worse.
The doctors note that the intense intestinal pressure from such an extensive backlog of logs can easily lead to a bowel blowout. Still, because the conditions are rare and poorly understood, doctors often strain to figure out how to best treat them.
In many cases, simple things like laxatives, enemas, and dietary changes can help. “However, if these methods fail, it is important to consider early surgical therapy,” the doctors concluded. And that would have likely helped in this case, they say, writing:
An earlier appreciation during a previous admission that this was a rare presentation of chronic idiopathic megacolon and megarectum may have prevented the perforation and elective surgery could have been planned.
The doctors performed a surgery that removed part of the man’s damaged colon and closed the hole. The publication did not include the follow-up that addressed the unidentified man’s recovery.
Image credit: Anyaegbuna, Apostolopoulos, Patel, BMJ Case Reports
BMJ Case Reports, 2018. DOI: ().