Types of megacolon
The congenital variant is Hirschsprung's disease, in which there are no nerve cells in a section of the intestine, it is constantly in spasm, and the overlying section expands. It appears in newborns or in early childhood. Acquired megacolon develops with prolonged constipation, damage to the nerve plexuses, systemic diseases, after spinal cord injuries and against the background of medications. The mechanical version occurs above an obstacle - a tumor or scar narrowing. Toxic megacolon is an acute dilation of severe inflammation of the intestine.
- Hirschsprung's disease is a congenital absence of nerve cells.
- Idiopathic megacolon in chronic constipation
- Secondary to neurological and systemic diseases
- Mechanical above tumor or narrowing
- Toxic for severe colitis or infection
- Medicinal when taking opioids and anticholinergics
Symptoms
Chronic forms develop over years. Stool becomes rare, once every few days or less, requires straining and is often only possible after laxatives or enemas. The abdomen is gradually enlarging, distension, rumbling and lack of feeling of complete emptying are disturbing. Pain, nausea, and loss of appetite may occur. Sometimes dense fecal stones form, and liquid stool leaks around them, which is mistaken for diarrhea. In the toxic form, everything develops within hours: severe bloating, fever, serious condition.
- Rare bowel movements and the need for enemas
- Enlargement and distension of the abdomen
- No feeling of emptying
- Bloating, rumbling, pain
- Fecal stones with leakage of liquid stool
- In the toxic form - fever and sudden deterioration
Diagnostics
They start with a plain X-ray of the abdominal cavity: it shows dilated loops, gas levels and allows one to suspect a toxic variant. Irrigography with contrast reveals the extent of expansion and the characteristic transition zone in Hirschsprung's disease. Colonoscopy is needed to exclude a tumor and evaluate the mucosa, but if toxic megacolon is suspected, it is not performed due to the risk of perforation. Computed tomography clarifies the condition of the wall and complications. The diagnosis of Hirschsprung's disease is confirmed by a biopsy of the intestinal wall.
- Plain radiography of the abdominal cavity
- Irrigography with contrast
- Colonoscopy outside the acute phase
- Computed tomography of the abdomen
- Biopsy of the intestinal wall for suspected Hirschsprung's disease
- Blood tests, electrolytes, TSH
Treatment of chronic forms
The goal is to ensure regular bowel movements and prevent complications. The doctor selects a regimen: a sufficient amount of fluid, a diet taking into account fiber tolerance, osmotic laxatives, if necessary, regular cleansing enemas and training in bowel movements. It is important to discontinue or replace drugs that inhibit motility. For Hirschsprung's disease, the main treatment is surgical - removal of a section of the intestine without nerve cells. Surgery is also discussed in case of severe dilatation that is not amenable to therapy, in case of volvulus and repeated complications. The scheme is determined by the doctor.
- Regular bowel movements according to a schedule chosen by your doctor
- Osmotic laxatives and enemas
- Sufficient drinking regime
- Individual approach to the amount of fiber
- Withdrawal of drugs that inhibit motility
- Surgical treatment for Hirschsprung's disease and complications
Toxic megacolon
This is an emergency condition that occurs in severe ulcerative colitis, Crohn's disease, and infectious colitis. The intestinal wall becomes inflamed throughout its entire thickness, loses tone and expands sharply, and there is a threat of perforation and peritonitis. Signs: rapidly increasing bloating, high fever, rapid heartbeat, dehydration, confusion, and diarrhea may decrease, which is mistaken for improvement. Treatment is carried out only in a hospital: infusions, antibiotics, treatment of the underlying disease, withdrawal of drugs that inhibit the intestines, if there is no effect - emergency surgery.
- Rapid bloating and fever
- Increased heart rate and dehydration
- Reduced diarrhea as a deceptive sign
- Immediate hospitalization and call 103
- Withdrawal of antidiarrheal and opioid medications
- Emergency surgery when there is a risk of perforation
