Gastrointestinal

Radiology

Gastrointest Radiol 4, 177-178 (1979)

Unused Colon in the Adult -

Roentgen Findings

D a v i d Bryk Department of Radiology, the Jewish Hospital and Medical Center of Brooklyn, and State University of New York, Downstate Medical Center, Brooklyn, New York, USA

Abstract. T w o cases are r e p o r t e d o f a c q u i r e d m i c r o c o Ion distal to l o n g - s t a n d i n g transverse c o l o s t o m i e s p e r f o r m e d 25 and 13 years previously. The r a d i o l o g i c a p p e a r a n c e o f the bypassed u n u s e d c o l o n was similar to that o f the m i c r o c o l o n o f infants, d e m o n s t r a t i n g shortening, t u b u l a t i o n , a n d lack of h a u s t r a t i o n s . Key words: B a r i u m e n e m a , c o l o n tomy, m i c r o c o l o n .

T r a n s v e r s e colos-

Bypass o f the c o l o n by p r o x i m a l c o l o s t o m y is usually a t e m p o r a r y p r o c e d u r e d o n e for neoplastic or inflamm a t o r y disease o f the left colon. The c o l o s t o m y is closed f o l l o w i n g resection of the lesion. This is a rep o r t o f two cases with transverse c o l o s t o m i e s in which the u n u s e d left c o l o n r e m a i n e d in situ for 25 and 13 years, respectively. This resulted in an a c q u i r e d microcolon.

Case Reports Case 1. A 69-year-old woman had been treated with radium and external radiotherapy for a carcinoma of the cervix 26 years previously. This resulted in a radiation stricture necessitating a transverse colostomy a year later. Rectal examination showed scarring with marked obliteration of the rectal lumen. On pelvic examination, there was induration without evidence of mass. Barium enema study through the colostomy demonstrated marked narrowing of the left colon with a gradual decrease in diameter distally. The colon was smooth with no haustrations and relatively short. The right colon was normal (Fig. 1). Case 2. A 67-year-old woman had been treated with radium and radiotherapy for a carcinoma of the cervix 14 years previously. One year later she developed a rectovaginal fistula for which a transverse colostomy was performed. Left hydronephrosis also developed which required a nephrostomy and subsequently a nephrectomy. On pelvic examination, there was diffuse induration consistent with fibrosis and no evidence of recurrent tumor. The barium enema study performed through the rectum demonstrated marked narrowing of the left colon, which was pencil-thin with absence

Address reprint requests to: Dr. D. Bryk, Director of Radiology, The Jewish Hospital and Medical Center of Brooklyn, 555 Prospect Place, New York, NY 11238, USA.

Fig. 1. Case 1. Transverse colostomy of 25 years' duration. Barium enema study via the colostomy with filling of both the proximal and distal barrels. The left colon is markedly narrowed and tubular with associated shortening and loss of haustrations. The right colon is normal

of haustrations (Fig. 2). In the lateral view, the rectorectal space was increased in diameter.

Discussion The cases r e p o r t e d d e m o n s t r a t e the m a r k e d a t r o p h y that can d e v e l o p after bypass. S o m e w h a t similar findings have been r e p o r t e d in the a n t r u m o f the s t o m a c h after l o n g - s t a n d i n g g a s t r o e n t e r o s t o m y p e r f o r m e d at least 12 to 15 years p r e v i o u s l y (1, 2). In these cases, the a n t r u m was n a r r o w a n d t u b u l a r with decreased distensibility. H i s t o l o g i c a l study indicated that the changes were due n o t only to m u c o s a l a t r o p h y , but also to m u s c u l a r h y p e r t r o p h y with increase in thickness o f the m u s c u l a r layers o f the gastric wall. In the colon, a similar a p p e a r a n c e has been n o t e d in infants in w h o m the m i c r o c o l o n was due to absence in the c o l o n o f the n o r m a l small b o w e l juices second-

9

0364-2356/79/0004-0177 $01.00 1979 S p r i n g e r - V e r l a g N e w Y o r k Inc.

178

D. Bryk: Unused Colon in the Adult

Fig. 2A and B. Case 2. Transverse colostomy of 13 years' duration. Barium enema study via the rectum. The left colon is pencil-thin with loss of haustrations

One case has been reported of prolonged partial colonic diversion in an adult who had a cecostomy for 51 years (4). In this case, the bypassed colon demonstrated extensive diverticulosis in addition to diffuse atrophy. It was postulated that the etiology of the diverticulosis was the small fecal stream entering the left colon. This was compared to the conditions present with a low-residue diet, which appears to predispose to colonic diverticulosis. The pathologic findings are not available in the cases reported. The radiologic picture was similar to that of the microcolon of the infant. Presumably, the colonic narrowing, shortening, and haustral loss occurred with elimination of the fecal stream. The changes are probably basically on an atrophic basis in which all layers of the colonic wall participate.

References

ary to distal small bowel obstruction (3). The lower the small bowel obstruction, the more severe was the microcolon. After restoration of intestinal continuity or relief of the obstruction, the colon rapidly reached its normal caliber.

1. Hajdu N, Hyde I, Riddell V: Antro-pyloric hypertrophy in patients with longstanding gastroenterostomies : a study of thirteen cases. Br J Radiol 41:49 54, 1968 2. Carter TL, Martel W : Contraction of the gastric a n t r u m following a long term gastroenterostomy: a report of two cases. Am J Roentgenol 91: 514-516, 1968 3. Berdon WE, Baker DH, Santulli TV, A m o r y RA, Blanc W A : Microcolon in newborn infants with intestinal obstruction: its correlation with the level and time of onset of obstruction. Radiology 90: 878-885, 1968 4. Baer J: Diverticulosis in an unused colon. A m J Gastroenterol 63:169 172, 1975

Received: August 24, 1978," aeeepted: September 20, 1978