Megacolon, hypoganglionosis, and cerebrovascular disease.
BACKGROUND
Gastrointestinal dysmotility has recently been recognized as a sequela of cerebrovascular accident.


METHODS
This paper reports the case of a 58-year-old man who presented to an emergency department with severe abdominal pain and distention. He had no prior history of constipation or other symptom of gastrointestinal dysmotility, but did suffer a cerebrovascular accident ten years previously. A diagnosis of colonic volvulus was made. Following partial mechanical decompression, sigmoid colectomy was performed, revealing a severely distended colon with marked wall thickening. Pathology revealed hypogangliosis and disrupted crypt architecture, establishing the diagnosis of idiopathic megacolon with hypogangliosis.


CONCLUSIONS
Chronic gastrointestinal dysmotility has recently been recognized as a sequela of cerebrovascular accident, but is also commonly found following other forms of central nervous system injury. This association likely follows disrupted communication between central autonomic regulatory pathways and intestinal enteric pacemakers.


CONCLUSIONS
Gastrointestinal dysmotility is a consequence of neurologic injury, and must be addressed in recommendations for long-term care following a cerebrovascular accident. Current recommendations focus on acute treatment, but do not recommend measures to promote colonic health and gastrointestinal motility.
Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Joshua M
JM
Levy
Clifford
C
McGinness
Bernard M
BM
Jaffe
D002561:Cerebrovascular Disorders / Q000150:complications*; D003082:Colectomy; D019299:Decompression, Surgical; D006627:Hirschsprung Disease / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D045822:Intestinal Volvulus / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008531:Megacolon / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged