Megacolon in teen-aged and adult patients

Summary

Megacolon may be classified as primary or aganglionic, secondary or acquired, and functional or psychogenic. In addition, there are other mechanisms, currently poorly understood, that cause megacolon.

Diagnostic studies of the patient with megacolon should include a detailed history, physical examination, rectal and sigmoidoscopic examinations, a rectal biopsy, and (for functional megacolon) psychiatric evaluation. Age of onset, encopresis, and dilatation and elongation of the colon with a narrow rectal or rectosigmoid segment are import details to consider in the differential diagnosis. Biopsy of the rectum will prove the presence or absence of ganglion cells. Careful attention should be given to patients with constipation, lest some of them be unnecessarily relegated to lifetimes of avoidable embarrassment and suffering.

We have described the cases of four patients with megacolon who had reached their teens or even young adulthood before being treated. The Swenson pull-through procedure produced excellent results in each case.