Mega-Cecum: An Unrecognized Cause of Symptoms in Some Female Patients with Uro-Gynecological Symptoms and Severe Slow Transit Constipation

Department

Surgery

Document Type

Article

Publication Title

Digestive Diseases and Sciences

Abstract

BACKGROUND: A subset of female patients with severe constipation report overlapping uro-gynecological symptoms which have been attributed to visceral hypersensitivity. AIMS: To study colon morphology and motor function in female patients with medically refractory chronic constipation with or without uro-gynecological symptoms and to assess clinical outcomes following laparoscopic ileo-proctostomy. METHODS: Colon anatomy and cecal emptying time were assessed with plain films and fluoroscopy following a standardized test meal mixed with barium. Transit time was determined with radiopaque markers. IBS-QOL and urinary incontinence questionnaires were employed to assess post-colectomy clinical response. RESULTS: In 21 consecutive patients, mean colon transit time (h) was 211.1 ± 11.3, which was significantly greater than 58.9 ± 5.1 of 10 normal subjects (P < 0.001). Mega-cecum was found in 15 (Group 1) with mean cecal volume of 587 ± 27.9 cm, significantly greater (P < 0.001) than 169.5 ± 10.4 cm of six without mega-cecum (Group 2). Mean cecal empting time (days) of barium-mixed feces in Group 1, 4.0 ± 0.6 was significantly greater than 1.33 ± 0.21 in Group 2 (P < 0.001). Eighteen patients (Groups 1 and 2) who had laparoscopic ileo-proctostomy experienced significantly improved quality of life (P < 0.001). In particular, Group 1 patients benefited significantly from improved uro-gynecological symptoms. CONCLUSIONS: Hitherto an unrecognized mega-cecum with markedly impaired emptying function was found in patients with severe slow transit constipation and uro-gynecological symptoms. Subtotal colectomy relieved constipation and improved significantly uro-gynecological symptoms, suggesting strongly that mega-cecum is causally related to these symptoms.

First Page

217

Last Page

223

DOI

10.1007/s10620-016-4392-y

Volume

62

Issue

1

Publication Date

1-1-2017

Medical Subject Headings

Adult; Aged; Anastomosis, Surgical; Barium Compounds; Cecal Diseases (complications, diagnostic imaging, physiopathology, surgery); Cecum (diagnostic imaging, physiopathology); Colectomy; Constipation (diagnostic imaging, etiology, physiopathology, surgery); Dyspareunia (etiology); Female; Fluoroscopy; Gastrointestinal Transit; Humans; Laparoscopy; Middle Aged; Organ Size; Quality of Life; Radiography; Urinary Incontinence (etiology); Young Adult

PubMed ID

27913997

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