Document Detail

Strategy for the surgical management of patients with idiopathic megarectum and megacolon.
MedLine Citation:
PMID:  11578298     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Several surgical procedures have been used to treat idiopathic megabowel. A structured approach to the surgical management of megarectum/colon is reported. METHODS: Twenty-eight consecutive patients with megabowel referred for surgery were reviewed. All patients had conservative treatment for 6 months. Those failing to improve underwent full-thickness biopsy of the anorectal junction, anorectal physiology studies, colonic transit studies and evacuation proctography. Surgery involved excision of the abnormal large bowel and formation of an anastomosis (coloanal or ileoanal) using 'normal' bowel identified either by a defunctioning stoma or colonic motility studies. RESULTS: Eight patients responded to conservative management. Two patients were lost to follow-up and one died from unrelated causes. Two of the 17 patients who underwent full-thickness biopsy were cured by the procedure. Anorectal physiology, colonic transit and evacuation studies did not aid selection of the surgical procedure performed in 15 patients: proctectomy and coloanal anastomosis (six), restorative proctocolectomy (three), panproctocolectomy (one) and defunctioning stoma (five). At a median follow-up of 3.6 years, 13 of 15 evaluable patients had a satisfactory outcome. CONCLUSION: Approximately 40 per cent of patients with megabowel referred for surgery responded to conservative treatment. The remaining patients may be treated successfully by surgery. The use of either a 'diagnostic' defunctioning stoma or colonic motility studies may aid in the choice of surgical procedure.
C B O Súilleabháin; J H Anderson; R F McKee; I G Finlay
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The British journal of surgery     Volume:  88     ISSN:  0007-1323     ISO Abbreviation:  Br J Surg     Publication Date:  2001 Oct 
Date Detail:
Created Date:  2001-10-01     Completed Date:  2001-10-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372553     Medline TA:  Br J Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  1392-6     Citation Subset:  AIM; IM    
Department of Coloproctology, Royal Infirmary, Glasgow G32 2ER, UK.
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MeSH Terms
Child, Preschool
Clinical Protocols
Colectomy / methods
Follow-Up Studies
Gastrointestinal Motility
Ileostomy / methods
Megacolon / physiopathology,  surgery*
Middle Aged
Patient Satisfaction
Proctocolectomy, Restorative / methods
Rectal Diseases / physiopathology,  surgery*
Comment In:
Br J Surg. 2002 May;89(5):623   [PMID:  12022128 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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