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

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 2016 Dec 4

PMID 27913997

Citations 2

Authors

William Y Chey

Vincent Chang

Cameron M Hoellrich

Kae Yol Lee

Maxine Lubkin

Deborah Corcoran

Ta-Min Chang

William D Chey

Affiliations

Soon will be listed here.

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.

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References

Gwee K, GRAHAM J, McKendrick M, Collins S, Marshall J, Walters S . Psychometric scores and persistence of irritable bowel after infectious diarrhoea. Lancet. 1996; 347(8995):150-3. DOI: 10.1016/s0140-6736(96)90341-4. View

Wood J . Enteric nervous system: sensory physiology, diarrhea and constipation. Curr Opin Gastroenterol. 2009; 26(2):102-8. DOI: 10.1097/MOG.0b013e328334df4f. View

Fass R, Fullerton S, Naliboff B, Hirsh T, Mayer E . Sexual dysfunction in patients with irritable bowel syndrome and non-ulcer dyspepsia. Digestion. 1998; 59(1):79-85. DOI: 10.1159/000007471. View

Brown J, Bradley C, Subak L, Richter H, Kraus S, Brubaker L . The sensitivity and specificity of a simple test to distinguish between urge and stress urinary incontinence. Ann Intern Med. 2006; 144(10):715-23. PMC: 1557357. DOI: 10.7326/0003-4819-144-10-200605160-00005. View

Lembo A, Zaman M, Krueger R, Tomenson B, Creed F . Psychiatric disorder, irritable bowel syndrome, and extra-intestinal symptoms in a population-based sample of twins. Am J Gastroenterol. 2009; 104(3):686-94. DOI: 10.1038/ajg.2009.23. View

Lyford G, He C, Soffer E, Hull T, Strong S, Senagore A . Pan-colonic decrease in interstitial cells of Cajal in patients with slow transit constipation. Gut. 2002; 51(4):496-501. PMC: 1773407. DOI: 10.1136/gut.51.4.496. View

Chey W, Jin H, Lee M, Sun S, Lee K . Colonic motility abnormality in patients with irritable bowel syndrome exhibiting abdominal pain and diarrhea. Am J Gastroenterol. 2001; 96(5):1499-506. DOI: 10.1111/j.1572-0241.2001.03804.x. View

Choung R, Richard Locke 3rd G, Zinsmeister A, Schleck C, Talley N . Psychosocial distress and somatic symptoms in community subjects with irritable bowel syndrome: a psychological component is the rule. Am J Gastroenterol. 2009; 104(7):1772-9. PMC: 3772628. DOI: 10.1038/ajg.2009.239. View

Chey W, Chang V, Lubukin M, Lee K, Hoellrich C, Chey W . Mega-cecum: a novel clinical entity which explains overlapping gastrointestinal and urogynecologic symptoms in women with chronic constipation. Am J Gastroenterol. 2013; 108(10):1665-6. DOI: 10.1038/ajg.2013.223. View

10.

Bassotti G, Villanacci V, Cretoiu D, Cretoiu S, Becheanu G . Cellular and molecular basis of chronic constipation: taking the functional/idiopathic label out. World J Gastroenterol. 2013; 19(26):4099-105. PMC: 3710411. DOI: 10.3748/wjg.v19.i26.4099. View

11.

Longstreth G, Yao J . Irritable bowel syndrome and surgery: a multivariable analysis. Gastroenterology. 2004; 126(7):1665-73. DOI: 10.1053/j.gastro.2004.02.020. View

12.

Whitehead W, Bosmajian L, Zonderman A, Costa Jr P, SCHUSTER M . Symptoms of psychologic distress associated with irritable bowel syndrome. Comparison of community and medical clinic samples. Gastroenterology. 1988; 95(3):709-14. DOI: 10.1016/s0016-5085(88)80018-0. View

13.

Whorwell P, McCallum M, Creed F, Roberts C . Non-colonic features of irritable bowel syndrome. Gut. 1986; 27(1):37-40. PMC: 1433171. DOI: 10.1136/gut.27.1.37. View

14.

Longstreth G, Grant Thompson W, Chey W, Houghton L, Mearin F, Spiller R . Functional bowel disorders. Gastroenterology. 2006; 130(5):1480-91. DOI: 10.1053/j.gastro.2005.11.061. View

15.

Hasler W, Schoenfeld P . Systematic review: Abdominal and pelvic surgery in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2003; 17(8):997-1005. DOI: 10.1046/j.1365-2036.2003.01499.x. View

16.

Drossman D, Patrick D, Whitehead W, Toner B, Diamant N, Hu Y . Further validation of the IBS-QOL: a disease-specific quality-of-life questionnaire. Am J Gastroenterol. 2000; 95(4):999-1007. DOI: 10.1111/j.1572-0241.2000.01941.x. View

17.

Heaton K, Ghosh S, Braddon F . How bad are the symptoms and bowel dysfunction of patients with the irritable bowel syndrome? A prospective, controlled study with emphasis on stool form. Gut. 1991; 32(1):73-9. PMC: 1379218. DOI: 10.1136/gut.32.1.73. View