title: Mega-Cecum: An Unrecognized Cause of Symptoms in Some Female Patients with Uro-Gynecological Symptoms and Severe Slow Transit Constipation.
abstract: A subset of female patients with severe constipation report overlapping uro-gynecological symptoms which have been attributed to visceral hypersensitivity.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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 cm3, significantly greater (P < 0.001) than 169.5 ± 10.4 cm3of 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.
  
  
  
  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.
authors.affiliation: Rochester Institute for Digestive Diseases and Sciences, Rochester, NY, USA. cheywilliamy@gmail.com.|, 33 Harrington Drive, Fairport, NY, 14450, USA. cheywilliamy@gmail.com.
authors.forename: William Y
authors.initials: WY
authors.lastname: Chey
authors.affiliation: Department of Surgery, Rochester General Hospital, Rochester, NY, USA.
authors.forename: Vincent
authors.initials: V
authors.lastname: Chang
authors.affiliation: Rochester Institute for Digestive Diseases and Sciences, Rochester, NY, USA.
authors.forename: Cameron M
authors.initials: CM
authors.lastname: Hoellrich
authors.affiliation: Rochester Institute for Digestive Diseases and Sciences, Rochester, NY, USA.
authors.forename: Kae Yol
authors.initials: KY
authors.lastname: Lee
authors.affiliation: Rochester Institute for Digestive Diseases and Sciences, Rochester, NY, USA.
authors.forename: Maxine
authors.initials: M
authors.lastname: Lubkin
authors.affiliation: Rochester Institute for Digestive Diseases and Sciences, Rochester, NY, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Corcoran
authors.affiliation: Rochester Institute for Digestive Diseases and Sciences, Rochester, NY, USA.
authors.forename: Ta-Min
authors.initials: TM
authors.lastname: Chang
authors.affiliation: Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, MI, USA.
authors.forename: William D
authors.initials: WD
authors.lastname: Chey
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D017609:Barium Compounds; D002429:Cecal Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D002432:Cecum / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003082:Colectomy; D003248:Constipation / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D004414:Dyspareunia / Q000209:etiology; D005260:Female; D005471:Fluoroscopy; D005772:Gastrointestinal Transit; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D009929:Organ Size; D011788:Quality of Life; D011859:Radiography; D014549:Urinary Incontinence / Q000209:etiology; D055815:Young Adult
chemical_list: D017609:Barium Compounds
keywords: Cecal dysmotility and stasis; Mega-cecum; Severe constipation; Slow colon transit; Uro-gynecological symptoms