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Mega-Cecum: An Unrecognized Cause of Symptoms in Some Female Patients with Uro-Gynecological Symptoms and Severe Slow Transit Constipation

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Abstract

Background

A subset of female patients with severe constipation report overlapping uro-gynecological symptoms which have been attributed to visceral hypersensitivity.

Aims

To study colon morphology and motor function in female patients with medically refractory chronic constipation with or without uro-gynecological symptoms and to assess clinical outcomes following laparoscopic ileo-proctostomy.

Methods

Colon anatomy and cecal emptying time were assessed with plain films and fluoroscopy following a standardized test meal mixed with barium. Transit time was determined with radiopaque markers. IBS-QOL and urinary incontinence questionnaires were employed to assess post-colectomy clinical response.

Results

In 21 consecutive patients, mean colon transit time (h) was 211.1 ± 11.3, which was significantly greater than 58.9 ± 5.1 of 10 normal subjects (P < 0.001). Mega-cecum was found in 15 (Group 1) with mean cecal volume of 587 ± 27.9 cm3, significantly greater (P < 0.001) than 169.5 ± 10.4 cm3 of six without mega-cecum (Group 2). Mean cecal empting time (days) of barium-mixed feces in Group 1, 4.0 ± 0.6 was significantly greater than 1.33 ± 0.21 in Group 2 (P < 0.001). Eighteen patients (Groups 1 and 2) who had laparoscopic ileo-proctostomy experienced significantly improved quality of life (P < 0.001). In particular, Group 1 patients benefited significantly from improved uro-gynecological symptoms.

Conclusions

Hitherto an unrecognized mega-cecum with markedly impaired emptying function was found in patients with severe slow transit constipation and uro-gynecological symptoms. Subtotal colectomy relieved constipation and improved significantly uro-gynecological symptoms, suggesting strongly that mega-cecum is causally related to these symptoms.

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Acknowledgments

We appreciate Ms. Youngjoo Park for her fine artwork for figures and Mr. Juho Kim, M.S., for calculating cecal volume. We also appreciate Ms. Kathleen Fulton, R.N., and George Fox, R.N., NP, for their support and excellent care for our patients. This work was supported by in part, by Louis S. and Molly B. Wolk Foundation and William B and Sheila Konar Foundation, Rochester, New York.

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Authors and Affiliations

  1. Rochester Institute for Digestive Diseases and Sciences, Rochester, NY, USA

    William Y. Chey, Cameron M. Hoellrich, Kae Yol Lee, Maxine Lubkin, Deborah Corcoran & Ta-Min Chang

  2. Department of Surgery, Rochester General Hospital, Rochester, NY, USA

    Vincent Chang

  3. Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, MI, USA

    William D. Chey

  4. 33 Harrington Drive, Fairport, NY, 14450, USA

    William Y. Chey

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  1. William Y. Chey
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  2. Vincent Chang
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  3. Cameron M. Hoellrich
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  4. Kae Yol Lee
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  5. Maxine Lubkin
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  6. Deborah Corcoran
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  8. William D. Chey
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Correspondence to William Y. Chey.

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Chey, W.Y., Chang, V., Hoellrich, C.M. et al. Mega-Cecum: An Unrecognized Cause of Symptoms in Some Female Patients with Uro-Gynecological Symptoms and Severe Slow Transit Constipation. Dig Dis Sci 62, 217–223 (2017). https://doi.org/10.1007/s10620-016-4392-y

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  • DOI: https://doi.org/10.1007/s10620-016-4392-y

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