JAMDA
Volume 8, Issue 5 , Pages 338-341 , June 2007

Megacolon and Stercoral Proctitis After Frequent Fecal Impactions: Report of an Unusual Case and Review of the Literature

  • Jen-Tzer Gau, MD

      Affiliations

    • Department of Geriatric Medicine/Gerontology, College of Osteopathic Medicine, Ohio University, Athens, OH
    • J.T.G. takes full responsibility for this case report and had access to the case record.
    • Corresponding Author InformationAddress correspondence to Jen-Tzer Gau, MD, 253 Grosvenor Hall, Ohio University College of Osteopathic Medicine, Athens, OH 45701.
    • ,
  • Utkarsh Acharya, BS

      Affiliations

    • Department of Geriatric Medicine/Gerontology, College of Osteopathic Medicine, Ohio University, Athens, OH
    • U.A. participated in the record tracking and preparing the manuscript.
    • ,
  • Tracy Marx, DO

      Affiliations

    • Department of Geriatric Medicine/Gerontology, College of Osteopathic Medicine, Ohio University, Athens, OH
    • T.M. and W.C. were involved in patient care and the editing of this manuscript.
    • ,
  • G. Nicholas Verne, MD

      Affiliations

    • Division of Gastroenterology, North Florida/South Georgia VA Medical System and Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL.
    • G.N.V. reviewed and edited the manuscript.
    • ,
  • Wayne Carlsen, DO

      Affiliations

    • Department of Geriatric Medicine/Gerontology, College of Osteopathic Medicine, Ohio University, Athens, OH
    • T.M. and W.C. were involved in patient care and the editing of this manuscript.

References 

  1. Grinvalsky HT, Bowerman CI. Stercoraceous ulcers of the colon: Relatively neglected medical and surgical problem. JAMA. 1959;171:1941–1946
  2. Haddad R, Bursle G, Piper B. Stercoral perforation of the sigmoid colon. Aust N Z J Surg. 2005;75:244–246
  3. Heffernan C, Pachter HL, Megibow AJ, et al. Stercoral colitis leading to fatal peritonitis: CT findings. AJR Am J Roentgenol. 2005;184:1189–1193
  4. Dubinsky I. Stercoral perforation of the colon: Case report and review of the literature. J Emerg Med. 1996;14:323–325
  5. Gattuso JM, Kamm MA. Clinical features of idiopathic megarectum and idiopathic megacolon. Gut. 1997;41:93–99
  6. Lim DK, Mahendran R. Risperidone and megacolon. Singapore Med J. 2002;43:530–532
  7. Nishida K, Nojiri I, Higashijima M, et al. Three cases of acquired megacolon in the elderly. Nippon Ronen Igakkai Zasshi. 1993;30:497–502
  8. Kraft E, Finby N, Egidio PT, Glenn JS. The megasigmoid syndrome in psychotic patients. JAMA. 1966;195:1099–1101
  9. Berenyi MR, Schwartz GS. Megasigmoid syndrome in diabetes and neurologic disease (Review of 13 cases). Am J Gastroenterol. 1967;47:311–320
  10. Demos TC, Blonder J, Schey WL, et al. Multiple endocrine neoplasia syndrome type IIB: Gastrointestinal manifestations. AJR Am J Roentgenol. 1983;140:73–78
  11. Sweeney AT, Malabanan AO, Blake MA, et al. Megacolon as the presenting feature in pheochromocytoma. J Clin Endocrinol Metab. 2000;85:3968–3972
  12. Burrell M, Cronan J, Megna D, et al. Myxedema megacolon. Gastrointest Radiol. 1980;5:181–186
  13. Hart AL, Kamm MA, Palmer JG, et al. An extra-ordinary cause of megacolon. Lancet. 1997;350:110
  14. Bolton RP, Read AE. Clostridium difficile in toxic megacolon complicating acute inflammatory bowel disease. BMJ. 1982;285:475–476
  15. Vlahos K, Theodoropoulos GE, Lazaris AC, et al. Isolated colonic leukocytoclastic vasculitis causing segmental megacolon: Report of a rare case. Dis Colon Rectum. 2005;48:167–171
  16. Lane RH, Todd IP. Idiopathic megacolon: A review of 42 cases. Br J Surg. 1977;64:307–310
  17. Preston DM, Lennard-Jones JE. Severe chronic constipation of young women: “Idiopathic slow transit constipation.”. Gut. 1986;27:41–48
  18. Barnes PR, Lennard-Jones JE, Hawley PR, et al. Hirschsprung’s disease and idiopathic megacolon in adults and adolescents. Gut. 1986;27:534–541
  19. Read NW, Abouzekry L, Read MG, et al. Anorectal function in elderly patients with fecal impaction. Gastroenterology. 1985;89:959–966
  20. von der Ohe MR, Camilleri M, Carryer PW. A patient with localized megacolon and intractable constipation: Evidence for impairment of colonic muscle tone. Am J Gastroenterol. 1994;89:1867–1870
  21. Wedel T, Spiegler J, Soellner S, et al. Enteric nerves and interstitial cells of Cajal are altered in patients with slow-transit constipation and megacolon. Gastroenterology. 2002;123:1459–1467
  22. Lee JI, Park H, Kamm MA, et al. Decreased density of interstitial cells of Cajal and neuronal cells in patients with slow-transit constipation and acquired megacolon. J Gastroenterol Hepatol. 2005;20:1292–1298
  23. Koch TR, Schulte-Bockholt A, Otterson MF, et al. Decreased vasoactive intestinal peptide levels and glutathione depletion in acquired megacolon. Dig Dis Sci. 1996;41:1409–1416
  24. Murray RD, Qualman SJ, Powers P, et al. Rectal myopathy in chronically constipated children. Pediatr Pathol. 1992;12:787–798
  25. Sonnenberg A, Tsou VT, Muller AD. The “institutional colon”: A frequent colonic dysmotility in psychiatric and neurologic disease. Am J Gastroenterol. 1994;89:62–66
  26. Rajagopal A, Martin J. Giant fecaloma with idiopathic sigmoid megacolon: Report of a case and review of the literature. Dis Colon Rectum. 2002;45:833–835
  27. Stratton JW, Mackeigan JM. Treating constipation. Am Fam Physician. 1982;25:139–142
  28. Wrenn K. Fecal impaction. N Engl J Med. 1989;321:658–662
  29. Annells M, Koch T. Faecal impaction: Older people’s experiences and nursing practice. Br J Community Nurs. 2002;7:118–126
  30. Brocklehurst JC, Kirkland JL, Martin J, Ashford J. Constipation in long-stay elderly patients: Its treatment and prevention by lactulose, poloxalkol-dihydroxyanthroquinolone and phosphate enemas. Gerontology. 1983;29:181–184
  31. Suilleabhain CBO, Anderson JH, McKee RF, Finlay IG. Strategy for the surgical management of patients with idiopathic megarectum and megacolon. Br J Surg. 2001;88:1392–1396
  32. Gladman MA, Scott SM, Lunniss PJ, Williams NS. Systematic review of surgical options for idiopathic megarectum and megacolon. Ann Surg. 2005;241:562–574

PII: S1525-8610(07)00005-9

doi: 10.1016/j.jamda.2007.01.004

JAMDA
Volume 8, Issue 5 , Pages 338-341 , June 2007

Article Tools

* Image Usage & Resolution