Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

Megacolon 963

Treatment Options

■Endoscopic decompression should be performed in patients who

do not respond to neostigmine or relapse. Surgical resection and

colostomy are indicated if ischemic bowel or perforation are sus-

pected.

■For Hirschprung’s disease-related enterocolitis, volume resusci-

tation and intravenous antibiotics, which should provide broad-

spectrum coverage against aerobic and anaerobic organisms.

Repeated rectal irrigation with saline decompresses the colon and

may decrease the severity of disease. Surgical excision of the agan-

glionic segment and a decompressing colostomy should be per-

formed as soon as the child is stable and the diagnosis established.

Side Effects and Complications

■Neostigmine causes bradycardia, colic, hypersalivation and nausea.

■Contraindications to treatment

■Neostigmine is contraindicated in true intestinal (mechanical) and

urinary obstruction, or bradycardia

follow-up

During Treatment

■In all cases of megacolon, surgical consultation should be obtained

upon admission, and the patient should be evaluated daily by both

the medical and surgical team. Bowel rest, and close monitoring.

Routine

■In chronic megacolon, colonic evacuation with osmotic laxatives

and enemas may suffice. A subtotal colectomy with ileorectal anas-

tomosis or a decopressive ileostomy may be needed.

complications and prognosis

■Volvulus is a rare complication of Hirschprung’s disease and chronic

megacolon. Clinical manifestations include abdominal pain and dis-

tension and vomiting. The diagnosis can be confirmed with a con-

trast enema, which may also detorse the volvulus. Surgery is indi-

cated if detorsion is unsuccessful or if bowel necrosis or perforation

is suspected.

■The prognosis in acute megacolon (Ogilvie’s syndrome) depends on

the underlying disease. Toxic megacolon carries very high mortality.