PSYCHOGENIC MEGACOLON MANIFESTED BY FECAL SOILING

Abstract

The results of surgical therapy in cases of aganglionic megacolon have tended to create the impression that all cases of megacolon can be benefited by surgery. The authors have described six patients in whom megacolon had a psychogenic origin; this group has been previously described as "functional" or "idiopathic," and its psychogenic origin has not been clearly recognized. Psychogenic megacolon may be diagnosed by the following clinical findings without the necessity of a detailed psychiatric history: admitting complaint of fecal soiling, onset in the second year of life or later, infrequent use of the toilet for defecation, defecation in the standing or supine position, inhibition of the stool, periodic voluminous stools, absence of episodes of intestinal obstruction, a feces-packed rectum, absence of a spastic segment of rectum or rectosigmoid using Neuhauser's fluoroscopic technic and a relatively benign course insofar as physical status is concerned. A sharp clinical distinction is apparent when the following findings of the aganglionic group are considered: admitting complaint of constipation without fecal soiling, onset at birth or in the first few weeks of life, use of the toilet for defecation, defecation in the sitting position, pellet-like or ribbon-like stools, frequent episodes of intestinal obstruction, an empty rectum, and the presence of a spastic segment of rectum or rectosigmoid using Neuhauser's fluoroscopic technic. A small additional group of cases has been described by others in which megacolon is due to anatomic obstruction; these cases can usually be diagnosed by digital examination of the rectum. The authors have classified the symptom of megacolon into three groups and have given them the following generic designations: psychogenic, neurogenic and anatomic. Only the neurogenic and anatomic groups are benefited by surgery.