Abstract
PurposeCT colonography enables three-dimensional measurement of colon length. However, previous studies using CT colonography have not examined the association with gender, age, physique, a history of laparotomy and bowel habits, all possible contributory factors to colon length. The aim of this study is to investigate factors associated with colon length.Materials and methodsWe conducted a post hoc analysis based on data obtained from a previous multi-center trial including 321 patients with positive fecal immunochemical tests who underwent CT colonography. Colon length was measured using a computer-generated center line and was divided at the iliac crest level into the distal and proximal colons. Bowel habits were classified into three groups: A—daily; B—once every 2 or 3 days; and C—less than once in 3 days. Statistical comparison was made using one-way ANOVA with Bonferroni’s correction.ResultsA total of 295 patients were analyzed. The entire colon length (cm, mean ± standard deviation) of individual patients was 150.3 ± 18.5 cm and ranged from 109.7 to 195.9 cm. The female colon was significantly longer than the male colon (154.3 ± 18.1 cm vs. 147.1 ± 18.3 cm; p = 0.022). Colon length showed trends associated with age (p = 0.18) and a history of laparotomy (p = 0.14). According to bowel habits, the entire colon measured 147.4 ± 17.9 in group A, 154.7 ± 18.5 in group B and 158.6 ± 18.3 in group C, and significant differences were observed for “A vs. C” (p = 0.002) and “A vs. B” (p = 0.014). In subgroup analysis by colon segment, the proximal colon trended similarly to the entire colon while there were no trends for the distal colon.ConclusionsThis study has clearly demonstrated that bowel habits and gender both correlate with the length of the entire colon measured by CT colonography, and in particular, the proximal colon.Secondary abstractUsing CT colonography, we measured the colon length in 295 patients. The entire colon length was 150.3 ± 18.5 cm on average. Females and constipated (less frequent defecation) patients have a significantly longer colon, and in particular, the proximal colon. Colon length showed trends associated with age and a history of laparotomy.
Highlights
Constipation is one of the most common chronic gastrointestinal conditions, which reportedly affects 14–17% of the population [1, 2], more frequently in females and the elderly [3], and adversely affects both physical and psychological quality of life [4]
The characteristics of patients by gender is shown in Supplementary Table 1
Bowel habits classified according to defecation frequency revealed 64% in the daily group, 23% in the intermediate group and 13% in the constipated group
Summary
Constipation is one of the most common chronic gastrointestinal conditions, which reportedly affects 14–17% of the population [1, 2], more frequently in females and the elderly [3], and adversely affects both physical and psychological quality of life [4]. In 1995, Saunders et al reported variations in colon length in 118 patients undergoing laparotomy, measuring according to a set protocol with the bowel pulled medially, mimicking the possible displacements that may occur during colonoscopy [11]. This measurement method possesses intrinsic limitations, e.g., inability to measure a colon with adhesions or a distal rectum, resulting in a shorter colon than using other methods. In another study to investigate colon anatomy and motility in young women with severe idiopathic constipation [16], the colon was longer in constipated women (n=37) than in controls (n=20), but the difference was not significant probably due to insufficient statistical power of the study
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