A case of idiopathic giant megacolon in an obese patientitle of image

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43-year-old man complaining of abdominal nausea starting 15 days earlier and vomiting was admitted to our emergency department. The patient was affected by a sever obesity with a BMI of 55.5; there was also an history of diabetes and hypertension. The abdomen was distended, diffusely painful, tympanic to percussion and the Blumberg sign was intensely positive; WBC count was 24,000x10³ with marked neutrophilia, hemoglobin 9.6 g/dl, with haematocrit 30.6%. A distended colon was present at plain RX abdomen while the CT cannot be performed due to the high BMI of the patient. At laparotomy a giant idiopathic megacolon was found and an Hartmann procedure was performed. The patient was discharged 15 postop with no complication. The anatomopathological examination documented a normal colon tissue. Diagnosis in obese patients is often difficult because they are paucisintomatic and the physical examination is difficult to achieve.

Figure 1.

Findings at laparotomy, giant megacolon