Acquired Megacolon (AMC) is a condition involving persistent dilatation and lengthening of the colon in the absence of organic disease. Diagnosis depends on subjective radiological, endoscopic or surgical findings in the context of a suggestive clinical presentation. This review sets out to investigate diagnostic criteria of AMC.
The literature was searched using the databases - PubMed, Medline via OvidSP, ClinicalKey, Informit and the Cochrane Library. Primary studies, published in English, with more than three patients were critically appraised based on study design, methodology and sample size. Exclusion criteria were studies with the following features: post-operative; megarectum-predominant; paediatric; organic megacolon; non-human; and failure to exclude organic causes.
A review of 23 articles found constipation, abdominal pain, distension and gas distress were predominant symptoms. All ages and both sexes were affected, however, symptoms varied with age. Changes in anorectal manometry, histology and colonic transit are consistently reported. Studies involved varying patient numbers, demographics and data acquisition methods.
Outcome data investigating the diagnosis of AMC must be interpreted in light of the limitations of the low-level evidence studies published to date. Proposed diagnostic criteria include: (1) the exclusion of organic disease; (2) a radiological sigmoid diameter of ~ 10 cm; (3) and constipation, distension, abdominal pain and/or gas distress. A proportion of patients with AMC may be currently misdiagnosed as having functional gastrointestinal disorders. Our conclusions are inevitably tentative, but will hopefully stimulate further research on this enigmatic condition.
Gladman MA, Knowles CH. Novel concepts in the diagnosis, pathophysiology and management of idiopathic megabowel. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2008;10(6):531–8. discussion 538-540 CrossRef
Loder P. Colorectal diseases: comment. Ausr NZ J Surg. 1998;68:299–300. CrossRef
Kantor J. A clinical study of some common anatomical abnormalities of the colon. American Roentgenray Society. 1924;
Ewing M. Dolichocolon. Aust, NZ J Surg. 1975;45(2):160–3. CrossRef
Melling J, Makin CA. Sigmoid volvulus, acquired megacolon and pseudo-obstruction. Surgery (Oxford). 2011;29(8):387–90. CrossRef
Pereira J, Horrigan F: Understanding adult acquired Megacolon. Geriatr Nurs 1987, January/February:16–19.
Liu R, Lin M, Yeh S. Dolichocolon: an incidental finding on gallium Scintigraphy. Clin Nucl Med. 1989;15(5):356. CrossRef
Kantor J. The common affections of the colon, their origin and their management. Bull N Y Acad Med. 1928;5(8):757–88.
Burrell ZL Jr. Acquired megacolon in the insane. Gastroenterology. 1957;33(4):625–30. PubMed
Moher DLA, Tetzlaff J, Altman DG, The PRISMA group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement . 2009.
Chen B, Knowles CH, Scott M, Anand P, Williams NS, Milbrandt J, Tam PK. Idiopathic slow transit constipation and megacolon are not associated with neurturin mutations. Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society. 2002;14(5):513–7. CrossRef
Gattuso JM, Hoyle CH, Milner P, Kamm MA, Burnstock G. Enteric innervation in idiopathic megarectum and megacolon. Int J Color Dis. 1996;11(6):264–71. CrossRef
Wedel T, Van Eys GJ, Waltregny D, Glenisson W, Castronovo V, Vanderwinden JM. Novel smooth muscle markers reveal abnormalities of the intestinal musculature in severe colorectal motility disorders. Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society. 2006;18(7):526–38. CrossRef
Ohkubo H, Masaki T, Matsuhashi N, Kawahara H, Yokoyama T, Nakajima A, Ohkura Y. Histopathologic findings in patients with idiopathic megacolon: a comparison between dilated and non-dilated loops. Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society. 2014;26(4):571–80. CrossRef
Goulston E. Diverticular disease of the colon and megacolon. Incidence in a psychiatric centre compared with a teaching hospital. Med J Aust. 1976;2(23):863–4. PubMed
Horvat N, Raj A, Ward JM, Smith JJ, Markowitz AJ, Gollub MJ. Clinical value of CT Colonography versus preoperative colonoscopy in the surgical Management of Occlusive Colorectal Cancer. AJR Am J Roentgenol. 2017:1–8.
Weinberg DS, Pickhardt PJ, Bruining DH, Edwards K, Fletcher JG, Gollub MJ, Keenan EM, Kupfer SS, Li T, Lubner SJ, et al. Computed tomography Colonography vs colonoscopy for colorectal cancer surveillance after surgery. Gastroenterology. 2017;
Taguchi N, Oda S, Imuta M, Yamamura S, Nakaura T, Utsunomiya D, Kidoh M, Nagayama Y, Yuki H, Hirata K, et al. Model-based iterative reconstruction in low-radiation-dose computed tomography Colonography: preoperative assessment in patients with colorectal cancer. Acad Radiol. 2017;
Lips LM, Cremers PT, Pickhardt PJ, Cremers SE, Janssen-Heijnen ML, de Witte MT, Simons PC. Sigmoid Cancer versus chronic Diverticular disease: differentiating features at CT Colonography. Radiology. 2014:132829.
Yucel C, Lev-Toaff AS, Moussa N, Durrani H. CT Colonography for incomplete or contraindicated optical colonoscopy in older patients. Am J Roentgenol. 2008;190(1):145–50. CrossRef
Galambos A, Galambos W. Redundancy of the colon. American Journal of Digestive Disease. 1946;13(3):87–101. CrossRef
- Symptoms and diagnostic criteria of acquired Megacolon - a systematic literature review
Alan de Costa
- BioMed Central
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