Case Report
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2005; 11(48): 7686-7687
Published online Dec 28, 2005. doi: 10.3748/wjg.v11.i48.7686
Recurrent severe gastrointestinal bleeding and malabsorption due to extensive habitual megacolon
Ingo Mecklenburg, Markus Leibig, Christof Weber, Stefan Schmidbauer, Christian Folwaczny
Ingo Mecklenburg, Christian Folwaczny, Department of Gastroenterology and Endoscopy, Medizinische Poliklinik, Ludwig-Maximilians-University, Munich, Germany
Markus Leibig, Department of Cardiology, Medizinische Poliklinik, Ludwig-Maximilians-University, Munich, Germany
Christof Weber, Institute for Clinical Radiology, Klinikum Innenstadt, Ludwig-Maximilians-University, Munich, Germany
Stefan Schmidbauer, Department of Surgery, Klinikum Innenstadt, Ludwig-Maximilians-University, Munich, Germany
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Christian Folwaczny, Medizinische Poliklinik, Klinikum Innenstadt, Ludwig-Maximilians-University, Pettenkoferstr. 8a, 80336 Munich, Germany. christian.folwaczny@med.uni-muenchen.de
Telephone: +49-89-5160-2625 Fax: +49-89-5160-4187
Received: March 1, 2005
Revised: August 1, 2005
Accepted: August 3, 2005
Published online: December 28, 2005
Abstract

Dilatation of the colon and the rectum, which is not attributable to aganglionosis, is a rare finding and can be the result of intractable chronic constipation. We report a rare case of a 29-year-old male patient with impressive megacolon, in whom Hirschsprung’s or Chagas disease was ruled out. In the present case, dilatation of the colon was most likely due to a behavioral disorder with habitual failure of defecation. Chronic stool retention led to a bizarre bulging of the large bowel with displacement of the other abdominal organs and severe occult blood loss. Because of two episodes of life-threatening gastrointestinal bleeding despite conventional treatment of constipation, a surgical approach for bowel restoration was necessary. Temporary loop ileostomy had to be performed for depressurization of the large bowel and the subsequent possibility for effective antegrade colonic lavage to remove impacted stools. Shortly after the operation, the patient was healthy and could easily manage the handling of the ileostomy. However, the course of the megacolon in this young adult cannot be predicted and the follow-up will have to reveal if regression of this extreme colonic distension with reestablishment of regular rectal perception will occur.

Keywords: Gastrointestinal bleeding, Malabsorption, Habitual megacolon