Redundant colon and refractory constipation in children
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LETTER
Redundant colon and refractory constipation in children Rishi Bolia 1
&
Nowneet Kumar Bhat 1
# Indian Society of Gastroenterology 2020
We read with great interest the article “Functional constipation or redundancy of the colon?” by Noviello et al. published in the April issue of the Indian J Gastroenterology [1]. In this retrospective study, the authors found that children with refractory constipation had a longer redundant rectosigmoid colon as compared with a reference population. This data were obtained from 67 children who underwent a contrast enema as a part of their evaluation. Through this study, the authors have highlighted a “forgotten” cause of refractory constipation. The redundant colon or dolichocolon is a congenital entity and was first reported in the 1920s. In these early studies, an incidence as high as 28.5% was reported [2]. However, subsequently, an interest in this entity seemed to wane away with only a few reports over the next three-quarters of a century. Raahave reported a high frequency of colonic redundancy in patients with constipation [2]. Yik et al. reported a 23% frequency of transverse colon elongation in children with slow transit constipation [3]. In the current study, information about the overall proportion of children with a dolichocolon is not mentioned. We think that this would be a useful piece of information. Can the authors please share it? We believe that this condition continues to be underrecognized and does not find a mention in current societal guidelines or position statements on constipation. In the current study, Noviello et al. have used ratios of the diameters and lengths of colonic segments to the width of the body of the second lumbar vertebra to standardize measurements. The authors concluded that a rectosigmoid length/L2 ratio > 15 was clinically significant; however, it is not clear how they arrived at this conclusion. Can the authors please shed some light on it?
* Rishi Bolia [email protected] 1
Division of Pediatric Gastroenterology, Department of Pediatrics, All India Institute of Medical Sciences, Virbhadra Road, Rishikesh 249 201, India
Regarding the pathophysiology of redundancy and constipation, the authors speculate that because of the elongated colon there is greater water reabsorption, resulting in hard stools and there is slow progression due to the tortuous bowel loops. We agree that these mechanisms might contribute to constipation but probably there are neurohumoral mechanisms at play too. In a study performed by Heredia et al. in mice, it was demonstrated that the elongation of the anal end of the colon evoked a premature colonic migratory motor complex (CMMC) and caused the CMMCs to propagate in an anal to oral direction [4]. CMMCs are neurally mediated rhythmic propulsions observed in the large intestine of mammals and are equivalent to high amplitude propagating contractions (HAPCs) in humans. Possibly, like mice, the same is occurring in humans with colonic lengthening reducing colonic motility and slowing transit. The t
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