Doctors insist on caution after a 24-year-old man in the UK underwent emergency surgery when they discovered that his severely enlarged colon, filled with feces, burst.
At the time of the operation the man had "reduced consciousness" and severe abdominal pain, as well as air trapped under his diaphragm, failing kidneys and acidic blood.
In a short notice published this week in BMJ case reports, doctors went deeper into the rare diseases of the man, known as "megacolon" and "megarectum." These are poorly understood ailments marked by enlarged guts that are not caused by a physical blockage. Sometimes they can be explained by genetic abnormalities or other acquired disorders, such as diseases that affect intestinal motility or muscle and connective tissue function. But in this case the man seemed to have a chronic, idiopathic case, which means that there was no clear cause of the gargantal guts.
Typically the diameter of the rectum of a healthy adult and the sigmoid colon (the S-shaped region of the colon closest to the rectum) is in the range of five to six centimeters or so. The guts of this man, however, had reached up to 18 centimeters in some points – and they were full of poop.
He had a long history of constipation and two days before doctors discovered that his colon had been torn into an emergency department. He had come to complain of stomach pain and diarrhea. His stomach was bloated, soft, and bumped out silent bowel sounds from, the doctors noticed. They sent him home with a plan to use laxatives and enema. But that turned out to be too little, too late. Days later his pain and symptoms had got worse.
The doctors note that the intense intestinal pressure of such & # 39; s extensive deprivation of wood logs can easily lead to an outbreak of the gut. But because the circumstances are rare and poorly understood, doctors often endeavor to find out how they can best be treated.
In many cases, simple things like laxatives, enema, and dietary changes can help. "However, if these methods fail, it is important to consider early surgical therapy," the doctors concluded. And that would probably have helped in this case, they write:
An earlier appreciation during an earlier recording that this was a rare presentation of chronic idiopathic megacolon and megarectum could possibly have prevented perforation and elective surgery from being planned.
The doctors performed an operation in which part of the damaged colon was removed from the man and the hole was closed. The publication did not include the follow-up that related to the recovery of the unidentified man.
Image credit: Anyaegbuna, Apostolopoulos, Patel, BMJ Case Reports
BMJ case reports, 2018. DOI: 10.1136 / bcr-2018-225406 (About DOI & # 39; s).