An unusual cause of idiopathic megacolon in a juvenile: A case report

Abstract

Rationale: Idiopathic megacolon (IMC) is a rare condition in young children. The association of indigestible food and IMC has never been mentioned in literature.

Patient concerns: An 11-year-old boy reported with a 1-year duration of intermittent constipation and abdominal distension after having eaten a large amount of fried sticky rice in 1 consumption.

Diagnoses: Chronic low colonic obstruction, IMC and malnutrition.

Interventions: This patient was managed conservatively for 1 week at first. Then he underwent loop ileostomy since conservative therapy was poorly tolerated. Enteral decompression, gut biopsy, peritoneal lavage, and drainage were performed in the same procedure.

Outcomes: Rapid weight gain was observed 4 months after operation.

Lessons: IMC is difficult to diagnose due to the lack of specific clinical manifestations and pathological features. The protocols for management of IMC remains controversial. To achieve a good long-term outcome, early intervention is recommended.

Figure 1

Preoperative abdominal CT scan showing dilated colon and distal ileum.

Figure 2

Distal ileum and proximal descending colon showing marked dilation during operation.

Figure 3

Clinical photography of the 11-year-old boy showing swelling abdomen with visible intestinal peristalsis.

Figure 4

Standard histology (hematoxylin-eosin [HE] staining) of dilated transverse colon sample showing degeneration neuropathy characterized by vacuolar degeneration of ganglion cells (arrows) and a slight reduction of myenteric plexus (×100 magnification).