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Curr Treat Options Gastroenterol. 1999 Dec;2(6):517-523.
Megacolon: Acute, Toxic, and Chronic.

Bharucha AE, Phillips SF.

Division of Gastroenterology and Hepatology, Mayo Clinic, 2-424 Alfred Building SMH, 200 First St. SW, Rochester, MN 55905, USA.

Megacolon refers to cecal dilatation above the dimension of 12 cm and above 6.5 cm of the sigmoid colon, measured at the pelvic brim. Dilatation of the colon can be broadly categorized into three clinical entities: In acute megacolon (Ogilvie's syndrome), colonic dilatation is attributed to a sympathetically mediated reflex response to a number of serious medical or surgical conditions in elderly patients. The initial tasks are to exclude mechanical obstruction (with a hypaque enema), to discontinue enabling medications, and to correct metabolic disturbances. Dilatation of the cecum to greater than 12 cm diameter is a cause for grave concern. The rectum should be decompressed with an indwelling tube and tap water enemas. Intravenous neostigmine is generally effective and safe for patients with colonic distention unresponsive to such conservative therapies. Endoscopic decompression is necessary for patients who do not respond to, or relapse after neostigmine, or in whom neostigmine is contraindicated. Signs of peritonitis may imply colonic perforation, and surgery will be needed, often on an emergent basis. Toxic megacolon is secondary to an identifiable inflammation of the colon. Therapy is directed toward specific treatment for the underlying disorder, inflammatory bowel disease, or infectious colitis. Bowel rest and close monitoring of the clinical status is vital. Colectomy may be needed under emergency circumstances. Chronic megacolon may be congenital (due to Hirschsprung's disease) or may represent the end-stage of any form of refractory constipation (slow transit constipation or pelvic floor dysfunction). The initial treatment for Hirschsprung's disease is surgery, while pelvic floor dysfunction and encopresis respond to biofeedback therapy. In chronic idiopathic megacolon, medical measures, such as colonic evacuation with enemas, fiber supplementation, and laxatives may suffice. If severe motor dysfunction is confined to the colon, a subtotal colectomy with an ileorectal anastomosis, or an ileostomy may occasionally be necessary.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11097735&dopt=Abstract [PubMed - as supplied by publisher]

Schweiz Med Wochenschr. 2000 Nov 18;130(46):1766-71.
[Surgery for idiopathic constipation. The modest role of successful surgery]

[Article in German]

von Flue M.

Chefarzt Chirurgische Klinik A Kantonsspital CH-6000 Luzern 16.

Treatment of idiopathic constipation requires precise definition of the physiological and pathophysiological changes. A colorectal work-up including colonoscopy, colorectal passage, colonic transit study, anorectal manometry, cinedefecography and electromyography help to distinguish between four different forms of idiopathic constipation: slow transit constipation, outlet obstruction, a combination of both problems and irritable bowel syndrome. 70% of patients with chronic constipation suffer from irritable bowel syndrome. In these cases there is no indication for surgery. Patients with pelvic outlet obstruction due to paradoxical puborectalis contraction can be successfully treated with biofeedback. Outlet obstruction due to rectal prolapse, rectocele and intussusception require surgery. Total colectomy with ileorectal anastomosis is the surgical option for selected patients with slow transit constipation. Where there is a mixed disorder, biofeedback for the outlet obstruction must be applied prior to colectomy for the inert colon. Thorough preoperative physiologic testing is mandatory for a successful outcome. When cases are carefully diagnosed and selected, the operative results are excellent.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11127956&dopt=Abstract

Curr Biol. 2000 Dec 14-28;10(24):1615-8.
A novel bacterial pathogen, Microbacterium nematophilum, induces morphological change in the nematode C. elegans.

Hodgkin J, Kuwabara PE, Corneliussen B.

MRC Laboratory of Molecular Biology, Hills Road, Cambridge CB2 2QH, UK. jaioch.ox.ac.uk

The Dar (deformed anal region) phenotype, characterized by a distinctive swollen tail, was first detected in a variant strain of Caenorhabditis elegans which appeared spontaneously in 1986 during routine genetic crosses [1,2]. Dar isolates were initially analysed as morphological mutants, but we report here that two independent isolates carry an unusual bacterial infection different from those previously described [3], which is the cause of the Dar phenotype. The infectious agent is a new species of coryneform bacterium, named Microbacterium nematophilum n. sp., which fortuitously contaminated cultures of C. elegans. The bacteria adhere to the rectal and post-anal cuticle of susceptible nematodes, and induce substantial local swelling of the underlying hypodermal tissue. The swelling leads to constipation and slowed growth in the infected worms, but the infection is otherwise non-lethal. Certain mutants of C. elegans with altered surface antigenicity are resistant to infection. The induced deformation appears to be part of a survival strategy for the bacteria, as C. elegans are potentially their predators.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11137017&dopt=Abstract

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