An Obscure Colon Dilatation and its Underlying Cause: Case Report and Literature Review

Anton Stift,Katharina Wöran,Felix Harpain,Thomas Mang,Kerstin Wimmer

doi:10.31487/j.gscr.2020.01.03

Abstract

Introduction: Congenital as well as acquired diseases may be responsible for the development of a megacolon. In adult patients, Clostridium difficile associated infection as well as late-onset of Morbus Hirschsprung disease are known to cause a megacolon. In addition, malignant as well as benign colorectal strictures may lead to intestinal dilatation. In case of an idiopathic megacolon, the underlying cause remains unclear. Case Presentation: We describe the case of a 44-year-old male patient suffering from a long history of chronic constipation. He presented himself with an obscurely dilated large intestine with bowel loops up to 17 centimeters in diameter. Radiological as well as endoscopic examination gave evidence of a spastic process in the sigmoid colon. The patient was treated with a subtotal colectomy and the intraoperative findings revealed a stenotic stricture in the sigmoid colon. Since the histological examination did not find a conclusive reason for the functional stenosis, an immunohistochemical staining was advised. This showed a decrease in interstitial cells of Cajal (ICC) in the stenotic part of the sigmoid colon. Discussion: This case report describes a patient with an idiopathic megacolon, where the underlying cause remained unclear until an immunohistochemical staining of the stenotic colon showed a substantial decrease of ICCs. Various pathologies leading to a megacolon are reviewed and discussed.

Highlights

Congenital as well as acquired diseases may be responsible for the development of a megacolon
This showed a decrease in interstitial cells of Cajal (ICC) in the stenotic part of the sigmoid colon
This case report describes a patient with an idiopathic megacolon, where the underlying cause remained unclear until an immunohistochemical staining of the stenotic colon showed a substantial decrease of ICCs

Summary

Introduction

The megacolon, with its variety of underlying causes, is a rare but potential life-threatening diagnosis in visceral surgery. A 44-year-old male patient presented himself at our outpatient clinic with an obscurely dilated abdomen, increasing dyspnea and tensional pain. He reported sequences of constipation altering with sequences of diarrhea since his childhood. After nine months without any further recorded outpatient clinic visits, the patient presented himself again at our clinic with an obscurely dilated abdomen, increasing dyspnea and tensional pain. He reported on constipation altering with discharge of very small amount of liquid stool. The patient reported a slightly increased defecation frequency up to 3 times a day but no other complaints

Discussion