| Objective:Analysis clinical data of 39 cases of adult megacolon,to facilitate a comprehensive understanding and improve the of diagnostic level of adult megacolon.Methods:Collected clinical data of 39 cases of adult megacolon in the first and the second affiliated hospital of Chongqing medical university.Design questionnaire of adult Hirschsprung's disease(AHD), adult HD allied disease (HAD) and adult organic megacolon on the basis of pathological result.It include sex,age, morbidity age,clinical characteristics, barium enema radiographs, anorectum inhibitory reflex,enteroscope exam,preoperative diagnosis,operation,pathological result,postoperative diagnosis complication and result of follow-up.Analysis the difference of clinical characteristics among 3 types of megacolon,and the reason of misdiagnosis.Results:1 17 cases in all were AHD,12 cases were male and 5 cases were female,the ratio of male to female is 2.4:1, the average age is (30.1±7.3).14 cases in all were HAD,12 cases were male and 2 cases were female,the ratio of male to female is 6:1, the average age is (27.7±5.9).8 cases in all were adult organic megacolon,5 cases were male and 3 cases were female, the ratio of male to female is 1.7:1,the average age is (46.2±13.8).2 The chief symptoms were constipation and distention (n=38,97.4%). Mostly patients were malnutrition(n=32,82.1%),some patients can be touched bumps of abdomen(n=22,56.4%).4 cases of AHD and 1 case(12.8%) of HAD were suffered bloodstool.There was 1 case(2.6%) showed belly ache,distension,diarrhea and bloody purulent stool who was diagnosed as toxic megacolon.3 34 cases of adult megacolon accepted barium enema radiographs: There were 11 cases(73.3%) of AHD and 5 cases(41.7%) of HAD found narrowed colonic segment,10 cases(66.7%) of AHD and 2 cases(16.7%) of HAD found transition zone,all the adult organic megacolon had no narrowed colonic segmen or transition zone.All of the 34 cases had a markedly dilated proximal colonic segment and could find retention of barium after 24 hours. Anorectum inhibitory reflex:12 cases of AHD and 2 cases of HAD were feminine. Rectal mucosa examination:2 case(66.7%) of AHD were masculine and 1 case(33.3%) was feminine;2 cases(100%) of HAD were feminine;100% organic megacolon was feminine.4 8 case(47.1%) of AHD were misdiagnosis before operation;8 case(57.1%) of HAD were misdiagnosis before operation;5 case(62.5%) of organic megacolon were misdiagnosis before operation.5 All of the 39 cases were treated by surgery.AHD:8 cases were treated by One or two stage meliorate Duhemal operation and 9 cases were treated by one or two stage meliorate Rehbein operation.HAD: 9 cases were treated by One or two stage meliorate Duhemal operation and 5 cases were treated by one or two stage meliorate Rehbein operation. Adult secondary megacolon:7 cases were treated by one or two stage colectomy and 1 cases were treated by one-stage meliorate Rehbein operation.5 Comparison of surgery treatment between meliorate Duhemal and colectomy:3 cases(17.6%) who were treated by meliorate Duhemal operation and 4 cases(28.6%) who were treated by meliorate Rehbein operation were suffered early-stage complications, 2 cases(22.2%) of meliorate Duhemal and 2 cases(28.6%) of meliorate Rehbein operation were suffered late-stage complications. Adult secondary megacolon:2 case (25.0%) was suffered early-stage complication.21 cases followed-up by telephone,all the patients had a condition of the anal function.Conclusion:Adult megacolon is rare and no typical characteristic,so it is frequently misdiagnosis.Combine results of barium enema radiographs, anorectum inhibitory reflex and enteroscope examination can significantly increase accurately diagnostic rate.There are kinds of operation to treatment, meliorate Duhemal operation and meliorate Rehbein operation is is not significative difference in early and late stage complication. It is important that frozen biopsy in surgery to decide the area of operation.
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