What Is Megacolon? Constipated Man's Bowel Rips after Filling with Feces

A 24-year-old man’s bowel became so packed with feces that it perforated, according to a case study report detailing conditions known as megarectum and megacolon. 

The unnamed man from London visited A&E complaining of abdominal pain and diarrhea experienced over the past week. Doctors examined him, and found his abdomen was swollen and tender, while his bowel was making “quiet sounds.”

A CT scan showed his rectum had dilated up to 18 centimeters and his colon was filled with feces, the authors of a paper published in BMJ Case Reports wrote.

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He was prescribed laxatives, but two days later his pain got worse. Tests revealed his kidney function was suffering, and surgeons at Newham University Hospital decided to perform emergency surgery on the patient to replumb his bowels in a technique called the Hartmann Procedure. The patient had suffered from chronic constipation in the four years leading to the 2018 surgery.

A megacolon or megarectum is a rare condition where the colon or rectum dilate without a mechanical obstruction. Those who develop the condition often experience recurrent constipation, as well as abdominal pain, bloating, and a swollen abdomen that often starts in childhood or adolescence. This potentially painful condition can also raise the risk of ulcers developing in the bowel wall and perforation.

In this case, medics diagnosed the man with chronic megacolon and megarectum, with an unknown cause. 

stomach-bowel-man-stock Surgeons performed emergency surgery on a man after he was diagnosed with megarecturm and megacolon. Getty Images

“The literature on managing these patients is not consistent and, thus, these patients present a serious management challenge to surgeons,” the authors of the paper wrote.

In many cases, megacolon doesn’t require surgery and can be treated using enemas. Patients might also need to watch what they eat.

But if this fails, a colectomy, where a segment of the colon is removed, may be necessary to restore normal digestive function.

“In this case, an earlier appreciation during a previous admission that this was a rare presentation of chronic idiopathic megacolon and megarectum may have prevented the perforation and elective surgery could have been planned,” the authors wrote.

In a similar case study from 2011, a 61-year-old woman with longstanding constipation also suffered a swollen stomach, as well as pain, nausea and weight loss. Fiber supplements and laxatives didn’t help the problem. Her colon was removed, and was found to measure 25.2cm in diameter, and weigh over 15kg. The case study was published in the Journal of General Internal Medicine.