Megacolon in Children

Megacolon is a condition in which the colon is abnormally dilated in a short space of time. Toxic substances build up in the intestines and can cause bowel perforation. In children, megacolon can be caused by several underlying conditions including Hirschprung's disease, Inflammatory Bowel Disease and constipation 1. Diagnosis of toxic megacolon is based on several physical findings and tests performed by your child's physician. Treatment is important as untreated megacolon can lead to serious complications and toxicity.


Hirschprung's disease is a congenital conditional in which the child is missing nerve cells that are responsible for the movement of stool through the bowel. Stool builds up in the affected area causing an obstruction. In rare cases megacolon can also be caused by inflammatory bowel disease 2.


Toxic megacolon causes an uncomfortable distension of the colon that involves inflammation. Your child might express feelings of pain, have a fever and a rapid heart rate. Patients also may experience dehydration. According to the Scott and White Children's Hospital, children can experience symptoms of shock.


Megacolon can be diagnosed on the basis of physical findings combined with tests like an abdominal X-ray. Your pediatrician might also want a complete blood count and blood electrolytes to see the effects this is having on your child's overall metabolic system. The physician can perform a rectal biopsy to see if the nerve cells that control bowel muscle movements are intact .


Treatment will depend on the cause of your child's megacolon. While the the dilated portion of colon usually needs to be surgically removed to prevent perforation, it is also important to treat the underlying cause of megacolon. Hirschprung's disease is treated surgically by removing the abnormal section of bowel. Three commonly performed operations are called the Swenson, Duhamel and Soave operations. According to Nationwide Children's Hospital all three operations have similar long-term results 1. Children with toxic megacolon caused by inflammatory bowel disease often require colonic resection 2. In a study performed by researchers in The Hospital for Sick Children in Toronto, Canada 70 percent of children with toxic megacolon caused by inflammatory bowel disease required colonic resection 12. Children will also receive fluids to prevent dehydration and shock. Because megacolon can lead to the leakage of stool contents and bacteria into the gastrointestinal system, patients often receive antibiotics to prevent severe infections known as sepsis. Children with functioning bowels can be given medication such as oral polyethylene glycol to help them move stools through their bowel.