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A Novel Approach to the Symptomatic Management of Chronic Megacolon

BACKGROUND: Chronic megacolon is a rare condition which primarily occurs in patients with autonomic dysfunction of a variety of causes. Its management is often challenging and people with chronic megacolon often suffer from abdominal distension, pain, and malabsorption. Given the struggles clinician...

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Autor principal: Ward, Michelle J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850843/
https://www.ncbi.nlm.nih.gov/pubmed/33564487
http://dx.doi.org/10.1155/2021/8820724
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author Ward, Michelle J.
author_facet Ward, Michelle J.
author_sort Ward, Michelle J.
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description BACKGROUND: Chronic megacolon is a rare condition which primarily occurs in patients with autonomic dysfunction of a variety of causes. Its management is often challenging and people with chronic megacolon often suffer from abdominal distension, pain, and malabsorption. Given the struggles clinicians experience in managing these patients long term, this case study provides an example of an alternate strategy for the symptomatic management of chronic megacolon. Case Description. An 80-year-old male with early Parkinson's disease developed megacolon following a basal ganglia stroke. He had a protracted hospital stay over 6 months due to malabsorption requiring total parenteral nutrition and electrolyte disturbances. A trial of subcutaneous neostigmine was unsuccessful, so patient underwent a trial of intermittent rectal tube decompression which improved his symptoms and malabsorption. This technique was then taught to the patient's wife until she was confident performing this herself. With continuation of decompression approximately every three days, the patient was able to return to oral nutrition and no longer required ongoing electrolyte replacement. He was able to be discharged into the community with significant improvement in his quality of life. CONCLUSION: This is the first report to suggest the benefit of intermittent rectal tube decompression in the community for the long-term management of chronic megacolon. Further prospective studies should evaluate the potential for this strategy to be implemented in a wider cohort of patients who are not responsive to existing treatments for chronic megacolon.
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spelling pubmed-78508432021-02-08 A Novel Approach to the Symptomatic Management of Chronic Megacolon Ward, Michelle J. Case Rep Surg Case Report BACKGROUND: Chronic megacolon is a rare condition which primarily occurs in patients with autonomic dysfunction of a variety of causes. Its management is often challenging and people with chronic megacolon often suffer from abdominal distension, pain, and malabsorption. Given the struggles clinicians experience in managing these patients long term, this case study provides an example of an alternate strategy for the symptomatic management of chronic megacolon. Case Description. An 80-year-old male with early Parkinson's disease developed megacolon following a basal ganglia stroke. He had a protracted hospital stay over 6 months due to malabsorption requiring total parenteral nutrition and electrolyte disturbances. A trial of subcutaneous neostigmine was unsuccessful, so patient underwent a trial of intermittent rectal tube decompression which improved his symptoms and malabsorption. This technique was then taught to the patient's wife until she was confident performing this herself. With continuation of decompression approximately every three days, the patient was able to return to oral nutrition and no longer required ongoing electrolyte replacement. He was able to be discharged into the community with significant improvement in his quality of life. CONCLUSION: This is the first report to suggest the benefit of intermittent rectal tube decompression in the community for the long-term management of chronic megacolon. Further prospective studies should evaluate the potential for this strategy to be implemented in a wider cohort of patients who are not responsive to existing treatments for chronic megacolon. Hindawi 2021-01-25 /pmc/articles/PMC7850843/ /pubmed/33564487 http://dx.doi.org/10.1155/2021/8820724 Text en Copyright © 2021 Michelle J. Ward. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Ward, Michelle J.
A Novel Approach to the Symptomatic Management of Chronic Megacolon
title A Novel Approach to the Symptomatic Management of Chronic Megacolon
title_full A Novel Approach to the Symptomatic Management of Chronic Megacolon
title_fullStr A Novel Approach to the Symptomatic Management of Chronic Megacolon
title_full_unstemmed A Novel Approach to the Symptomatic Management of Chronic Megacolon
title_short A Novel Approach to the Symptomatic Management of Chronic Megacolon
title_sort novel approach to the symptomatic management of chronic megacolon
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850843/
https://www.ncbi.nlm.nih.gov/pubmed/33564487
http://dx.doi.org/10.1155/2021/8820724
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