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An 8-year-old neutered male, Wood constitution, Maine Coon cat was presented with a 22-month history of severe constipation and megacolon. With conventional medications and an enema every 2-3 months, he could produce a soft, wet, large stool on average once every 14-16 days. Clinical exam findings included an animal with weight loss, bilateral deep weak pulses, a wet pink tongue and radiographs demonstrating a large, stool-impacted descending colon. A TCVM Pattern of Spleen Qi Deficiency was diagnosed. Due to his Wood constitution attitude about prolonged handling, a small number of acupuncture points at easily accessible locations were chosen for his treatment. Acupuncture techniques used included dry needle, aqua-acupuncture and electro-acupuncture. Over a 4-month period with 5 acupuncture sessions, the severe constipation slowly resolved. This case is an excellent clinical example of using TCVM treatment to address a difficult, poorly responsive clinical condition frequently seen in geriatric cats. [ABSTRACT FROM AUTHOR]

Purpose: The Soave procedure (SO) is performed most commonly for Hirschsprung disease. SO reduces the risk of injury to the pelvic structures; however, a residual aganglionic muscle cuff could interfere with bowel movement and lead to obstructive enterocolitis. The Swenson procedure is considered ideal in terms of peristalsis. Currently, laparoscopic surgery provides better visualization and facilitates precise dissection, possibly leading to feasible performance of the laparoscopic modified Swenson procedure (SW). We present our operative technique and the efficacy of the SW compared with that of SO.Methods: We retrospectively reviewed the records of 16 and 27 patients who underwent SW and SO, respectively, between 2012 and 2017.Results: Operative time, blood loss, length of stay, and frequency of bowel movements showed no significant difference between the two groups. In the SW group, temporary dysuria occurred in one patient, postoperative enterocolitis in two, wound infection in one, and severe perianal excoriation in four, whereas in the SO group, obstructive symptoms occurred in three patients, small-bowel obstruction in one, and severe perianal excoriation in three. The complications and outcomes were comparable between both groups.Conclusion: Laparoscopic SW was safe and feasible for the short-term follow-up outcomes. [ABSTRACT FROM AUTHOR]

Toxic megacolon can be a form of severe clinical course of the infection with Clostridium difficile (ICD), lifethreatening, requiring a particular course of treatment. Infection with Clostridium difficile in the Galati Infectious Disease Hospital presents rising number of cases, namely 172 cases in 2014, 271 cases in 2015 and 301 cases in 2016 with clinical evolutions with different severity degrees, including toxic megacolon and death. Among 744 patients with ICD in our clinic, since 1st January 2014 to 31 December 2016. The frequency of toxic megacolon (TM) was 0,537%, so: 3 toxic megacolon cases with favorable evolution with treatment with vancomycin and metronidazole and just one case whose evolution was aggravated under this therapy and evolved favorably under treatment with tigecycline. The work presents this last case of ICD occurred in a 69 years old, immunocompetent man with unknown concomitant chronic diseases which undergoes surgery for bilateral inguinal hernia and receives antibiotherapy with cephalosporin IIIrd generation during surgery and after 7 days develops medium degree ICD with score Atlas 3 and receives therapy with oral vancomycin. He presents clinical aggravation during this therapy with the occurrence of colon dilatation, ascites and right pleurisy at ultrasound and therapy associated with metronidazole is decided. Clinical aggravation continues in this combined therapy with defining the clinical, colonoscopy and tomography criteria for TM and is decided surgical monitoring and replacing antibiotherapy with tigecycline. Evolution is favorable with tigecycline without surgical intervention. [ABSTRACT FROM AUTHOR]

We present the case of a 58-year-old man who underwent urgent blowhole colostomy for toxic megacolon (TM) secondary to Clostridium difficile infection (CDI). This infection occurred under antibiotic coverage with amoxicillin-clavulanic acid, four days after laparoscopic sigmoidectomy in our hospital. Although prospective clinical research regarding the surgical management of TM is lacking, decompressive procedures like blowhole colostomy are reported to carry a high risk of postoperative morbidity and mortality and are widely regarded as obsolete. Subtotal or total colectomy with end ileostomy is currently considered the procedure of choice. After presenting our case, we discuss the literature available on the subject to argue that the scarce evidence on the optimal surgical treatment for TM is primarily based on TM associated with inflammatory bowel diseases (IBD) and that there might be a rationale for considering minimally invasive procedures like blowhole colostomy for CDI-associated TM. [ABSTRACT FROM AUTHOR]

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We developed a novel murine model of long-term infection with Trypanosoma cruzi with the aim to elucidate the pathogenesis of megacolon and the associated adaptive and neuromuscular intestinal disorders. Our intent was to produce a chronic stage of the disease since the early treatment should avoid 100% mortality of untreated animals at acute phase. Treatment allowed animals to be kept infected and alive in order to develop the chronic phase of infection with low parasitism as in human disease. A group of Swiss mice was infected with the Y strain of T. cruzi. At the 11th day after infection, a sub-group was euthanized (acute-phase group) and another sub-group was treated with benznidazole and euthanized 15 months after infection (chronic-phase group). Whole colon samples were harvested and used for studying the histopathology of the intestinal smooth muscle and the plasticity of the enteric nerves. In the acute phase, all animals presented inflammatory lesions associated with intense and diffuse parasitism of the muscular and submucosa layers, which were enlarged when compared with the controls. The occurrence of intense degenerative inflammatory changes and increased reticular fibers suggests inflammatory-induced necrosis of muscle cells. In the chronic phase, parasitism was insignificant; however, the architecture of Aüerbach plexuses was focally affected in the inflamed areas, and a significant decrease in the number of neurons and in the density of intramuscular nerve bundles was detected. Other changes observed included increased thickness of the colon wall, diffuse muscle cell hypertrophy, and increased collagen deposition, indicating early fibrosis in the damaged areas. Mast cell count significantly increased in the muscular layers. We propose a model for studying the long-term (15 months) pathogenesis of Chagasic megacolon in mice that mimics the human disease, which persists for several years and has not been fully elucidated. We hypothesize that the long-term inflammatory process mediates neuronal damage and intramuscular and intramural denervation, leading to phenotypic changes in smooth muscle cells associated with fibrosis. These long-term structural changes may represent the basic mechanism for the formation of the Chagasic megacolon. [ABSTRACT FROM AUTHOR]

Background: Migration from Latin American countries has increased the number of cases of chagasic megacolon in Western countries. Megacolon is a late complication of Chagas disease, resulting from irreversible destruction of the intramural intestinal nervous system with extensive loss of neurons, ganglionitis, and myositis at the sites of the myenteric and submucosal plexuses. Several surgical procedures involving partial or total resection of the dilated colon have been proposed for treating chagasic megacolon, but intra-operative evaluation of neuronal degeneration in the residual colon has not been commonly done. Methods: Case report and literature review. Case Report: We describe a case of chagasic megacolon treated successfully with a modified Habr-Gama technique, with the intra-operative examination of frozen sections of the residual segments of the colon for the presence of neurons. Conclusions: The recurrence of constipation after surgical treatment can result from the progression of chagasic neuronal degeneration in the preserved colon, and may be preventable by intra-operative evaluation of whether signs of neuronal degeneration or inflammation are absent in the anastomosed colonic tract. [ABSTRACT FROM AUTHOR]

Background. Hirschsprung disease is a relatively rare condition, initially described as a cause of constipation in early infancy, and it is managed by pediatric surgeons. Significant advances have been made in understanding its etiologies in the last decade, especially with the explosion of molecular genetic techniques and early diagnosis. The surgical management has progressed from a two- or three-stage procedure to a primary operation. Methods. This retrospective study involves 74 patients diagnosed with Hirschsprung's Disease at the Surgery Clinic of "Grigore Alexandrescu" Emergency Hospital for Children from 1.1.2000 to 1.1.2011. For better analysis of diagnosis and treatment evolution, the group was split according to admission date into two smaller groups, each one containing 37 patients.Results. Age at dignosis has decreased in 2006-2011 interval, 32.4% of patients being newborns and 24.3% infants. In 2000-2005 only 24.3% were newborns and 21.6% infants. This results are correlated with a shorter hospital stay and period from diagnosis to surgery. Our results are all compared with the literature dates at the moment. Conclusion. Our clinic has improved its diagnosis and treatment methods for HD during the last 11 years. The age at diagnosis has decreased, along with the hospital stay and the time from diagnosis to surgery. Different procedures are used according to the case. As a result, patients are getting better and more suitable treatment with lower costs and lesser complications. Follow-up studies have shown very good results in long-term quality of life [ABSTRACT FROM AUTHOR]

Megacolon refers to an abnormal dilatation of the colon. This condition occurs in both humans and animals. Although it seems to be more common in cats, megacolon may also occur in dogs. However, data regarding the etiopathogenesis, clinical course and outcome of canine megacolon are scarce. The aim of this study is to present the experience of our team in diagnosis and therapy of canine acquired megacolon, with particular reference to etiopathogenetic aspects. The prospective study included 28 dogs affected with megacolon, aged 5-9 years. The 26 animals underwent a surgical procedure (colonotomy followed by manual extraction of faeces), and were followed up for a period of 28 days. On the basis of anamnestic data, clinical and radiographic findings, 7 dogs (25%) were presented with idiophatic acquired megacolon, while 75% of cases had secundary acquired megacolon of different etiology (including pelvic canal stenosis, lumbar and sacral spinal injuries or back leg fractures, in 46% od cases; keeping the animals in the backyard and irresponsibility of their owners, in 11%; non-adequate nutrition, in 11%; and decreased physical activity and keeping animals in small flats, i 7%). During early postoperative period, the medical treatment and dietary regimen enabled defecation in 65% of cases. The remaining 35% of cases were treated with Cisapride in order to establish spontaneous defecation. All dogs recovered completely during the 28- days follow-up period. According to the results of interviews with dog owners, all animals were in good condition six months after the surgical procedure. [ABSTRACT FROM AUTHOR]

Purpose: The aim of study was to evaluate if pelvic ultrasound can be useful in managing children with chronic idiopathic constipation.Methods: A total of 270 children with idiopathic chronic constipation were enrolled in the study. At baseline and at monthly checkups children were evaluated by clinical score and pelvic ultrasound (US). Patients have been divided in 2 groups, based on pelvic US results: group A with a rectal diameter >3 cm, group B with a rectal diameter <3 cm or rectum not visualized. Both groups were subsequently randomly divided in two subgroups (A1, A2, B1, B2) on the basis of the prescribed treatment (disimpaction for the first week and daily laxative or only daily laxative).Results: After 1 month of therapy all clinical features improved in group A1 and at pelvic US, rectal size reduced and became not visualized; group A2 showed poor clinical response and transverse diameter of rectum did not modify significantly; B1 and B2 groups showed significant improvement only after 2-3 months.Conclusions: Rectal disimpaction is necessary only in presence of MR. Pelvic US is a useful to diagnose MR and to set up the most appropriate treatment protocol for different chronic constipation cases. [ABSTRACT FROM AUTHOR]

Megacolon refers to an abnormal dilatation of the colon. This condition occurs in both humans and animals. Although it seems to be more common in cats, megacolon may also occur in dogs. However, data regarding the etiopathogenesis, clinical course and outcome of canine megacolon are scarce. The aim of this study is to present the experience of our team in diagnosis and therapy of canine acquired megacolon, with particular reference to etiopathogenetic aspects. The prospective study included 28 dogs affected with megacolon, aged 5-9 years. The 26 animals underwent a surgical procedure (colonotomy followed by manual extraction of faeces), and were followed up for a period of 28 days. On the basis of anamnestic data, clinical and radiographic findings, 7 dogs (25%) were presented with idiophatic acquired megacolon, while 75% of cases had secundary acquired megacolon of different etiology (including pelvic canal stenosis, lumbar and sacral spinal injuries or back leg fractures, in 46% od cases; keeping the animals in the backyard and irresponsibility of their owners, in 11%; non-adequate nutrition, in 11%; and decreased physical activity and keeping animals in small flats, in 7%). During early postoperative period, the medical treatment and dietary regimen enabled defecation in 65% of cases. The remaining 35% of cases were treated with Cisapride in order to establish spontaneous defecation. All dogs recovered completely during the 28- days follow-up period. According to the results of interviews with dog owners, all animals were in good condition six months after the surgical procedure. [ABSTRACT FROM AUTHOR]

Background: Toxic megacolon (TM) is a potentially lethal complication of idiopathic inflammatory bowel disease or infectious colitis, characterized by total or segmental non-obstructive colonic dilatation of at least 6 cm associated with systemic toxicity. Methods: Overall, 15 patients had surgery for TM at our institutions over a 10-year period (1993–2003). In contrast to other studies that used medical therapy as the first-line treatment for TM, in our experience all patients underwent surgery as soon as possible after diagnosis of TM (early surgery). Results: 14 patients underwent subtotal colectomy with terminal ileostomy, while for 1 patient the surgical procedure consisted only in a decompressive cecostomy. Two major complications occurred consisting of 2 cases of multiple organ failure leading to death. No other major complications or deaths were reported. The overall mortality rate was therefore 13% (0% in patients <65 years). Conclusion: This study shows that early surgery has the potential to represent a valid therapeutic strategy for patients with TM resulting in a small number of TM-related complications and deaths. Elderly patients seem to have a high risk of multiple organ dysfunction syndrome and post-surgical death. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Leukocytapheresis (LCAP) is a method of therapeutic apheresis to remove patients' peripheral leukocytes by extracorporeal circulation. Previous studies showed that LCAP for the treatment of ulcerative colitis (UC) was more effective and had fewer adverse effects compared to high-dose steroid therapy. However, there are no reports on the application of LCAP for UC patients with toxic megacolon (TM). This study reports the effectiveness and safety of LCAP in treating patients with severe or fulminant UC with TM. Six patients were enrolled in this study and LCAP sessions were performed three times per week for 2 weeks, followed by four further times in the next 4 weeks. After completion of therapy, four patients improved in TM and went into the remission stage of UC. The average Rachmilewitz clinical activity index of these four patients improved from 19.5 to 1. The remaining two patients had to undergo colectomy, however, the symptoms had been mitigated by LCAP and the operations were completed without any problems. These results suggest that LCAP is an additional effective and safe option for TM management in preventing colectomy or for bridging to a safer operation. [ABSTRACT FROM AUTHOR]

Presents a study that examined autologous transplantation in patients with amyloidosis, with an emphasis on unique gastrointestinal toxicities that include toxic megacolon. Medical background of the patients used in the study; Characteristics of amyloidosis; Application of high-dose therapy in patients of amyloidosis.

We report a patient who survived total colonic type ulcerative colitis (UC) complicated by toxic megacolon (TM), disseminated intravascular coagulation (DIC), methicillin-resistant Staphylococcus aureus infection, and phlebothrombosis. A 69-year-old man was treated for about 4 months under the diagnosis of ischemic colitis at another hospital, and was transferred to our hospital. Based on endoscopic and pathological findings, we strongly suspected UC, and administered salazosulfapyridine and methylprednisolone, but TM and DIC developed, necessitating urgent subtotal colectomy. Despite his elderly age and the severe complications, he recovered and was discharged from our hospital about 4 months after admission. The mortality rate of UC complicated by TM and DIC in elderly patients is high, necessitating rapid initiation of high-dose steroid administration or surgical treatment. [ABSTRACT FROM AUTHOR]

The article presents case studies on the subtotal colectomy through rectal pull-through for idiopathic megacolon treatment in two neutered male cats, one is a 12-year-old Siamese cat and the other is a 7-year-old British short-haired cat, both with recurrent constipation. It discusses the pre-operative treatment before surgery as well as the post-operative treatment. Moreover, the conservative management of recurrent constipation is cited.

Balloon enteroscopy (BE) was originally developed for observation of the deep small intestine, and has recently been utilized for difficult cases of total colonoscopy due to reasons such as adhesions and elongation. In this report, we present our experience with single balloon enteroscopy (SBE) to facilitate successful colonoscopy when standard techniques failed. In two cases, early colon cancers were detected in the cecum by SBE and were removed endoscopically or surgically. A third case is discussed in which SBE was attempted but was ultimately not successful. In that case, total colonoscopy was not performed because of looping in the sigmoid and transverse colon. A fourth case in which SBE was performed in order to remove colonic gas in a patient with megacolon. In that case, total colonoscopy could not be completed because the SBE balloon could not "grab" the dilated colon and therefore could not advance. SBE is a useful adjunct to standard colonoscopy in challenging cases, but has limitations and does not always ensure success. [ABSTRACT FROM AUTHOR]

The article presents a case study of idiopathic sigmoid megacolon with fecal impaction and giant calcified fecaloma in a 58-year-old male inmate. Abdominal computed tomography revealed fecal impaction throughout the dilated sigmoid megacolon and also a large calcified mass in the rectum. A sigmoidectomy and terminal colostomy were performed. The patient developed peritonitis after the rectal stump perforated and died of multiorgan failure.

Presents the case of a 41-year-old man with bloody diarrhea. Diagnosis and treatment of ulcerative colitis; Hyperbaric oxygen and interleukin 6 level; Intravenous prednisolone being changed to oral prednisolone; Complication of toxic megacolon; Suggestion of hyperbaric oxygen as a promising non-surgical treatment.

Chagas' disease is endemic in South America, affecting several million people. Megacolon, the commonest intestinal manifestation, causes severe constipation and usually requires surgery. We report a case which was treated by restorative proctocolectomy. We believe this to be a useful new technique in the treatment of this condition. [ABSTRACT FROM AUTHOR]