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Colon: megacolon syndrome

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Synonym(s): Rabbit megacolon syndrome (RMS), Megacolon, Chronic diarrhea syndrome

Introduction

  • Rabbit megacolon syndrome (RMS) is a poorly understood disease process whereby individual rabbits have chronic intermittent diarrhea. The feces are often described as ‘cowpat’-like.
  • Cause: the etiology is currently unclear, although spotted rabbits may have a genetic predisposition. There is some debate as to whether RMS covers a single condition or group of conditions, and as to whether some of the clinical signs seen may be attributed to an inflammatory bowel disease syndrome.
  • Signs: chronic, intermittent diarrhea with progressive weight loss and occasional bouts of painful cecal tympany, gastrointestinal stasis and anorexia. The rabbit’s appetite between such episodes is usually very good.
  • Diagnosis: no specific test for megacolon is available, but a high suspicion is raised in rabbits with chronically abnormal feces, weight loss despite a ravenous appetite, and intermittent bouts of cecal tympany and gastrointestinal stasis. The colon and cecum may be palpably distended. Blood analysis may show anemia, hypoproteinemia and hypoglobulinemia, whilst fecal cytology may show long fiber particles along with altered microbiota. Abdominal radiography may show the colon and cecum to be distended, particularly during bouts of tympany.
  • Treatment: the syndrome is progressive and incurable, although symptoms may be controlled by diet and medications. The time course appears to vary widely between individuals.
  • Prognosis: guarded in the long-term.
Print off the Factsheets on Megacolon syndrome and Diarrhea to give to your clients.

Presenting signs

  • Chronic abnormal feces, ranging from ‘cowpat’-like, to soft but variable in size including very large fecal pellets Diarrhea: overview. The feces often appear to be a mixture of pellets and cecotrophs, ie long fiber particles with cecal micro-organisms, but not normal pellets or cecotrophs .
  • Over an extended period of time, the rabbit will lose condition whilst the abdomen becomes distended.
  • The rabbit’s appetite is often ravenous, other than during intermittent periods of cecal tympany and gastrointestinal pain.

Acute presentation

  • Often an acute-on-chronic presentation whereby the rabbit shows acute signs of abdominal pain and anorexia Anorexia secondary to the chronic megacolon signs.

Geographic incidence

  • Cases have been reported worldwide, but it appears to be rare.

Age predisposition

  • Tends to be seen in mature rabbits, generally over 3 years old.

Gender predisposition

  • No obvious sex predisposition.

Breed/Species predisposition

  • Rabbits with spotted markings, such as the English Spot, appear to have a genetic predisposition, although cases have been seen in non-spotted rabbits.
  • Various papers indicate a genetic predisposition in certain breeding populations.
  • Hybridization may influence the disease but doesn’t affect inclination to megacolon in EnEn homozygous spotted rabbits.

Public health considerations

  • No public health concerns known at this point.

Cost considerations

  • The condition is progressive and so the rabbit is likely to need ongoing dietary management and potentially medications.
  • There may be intermittent bouts of abdominal pain and gastrointestinal stasis Gastric dilation and stasis which may need to be managed medically, potentially requiring hospitalization Hospitalization/nursing care.
  • Owner should be counselled on the potential costs.

Special risks

  • No specific risks.

Pathogenesis

Etiology

  • Currently unknown but likely to have a genetic predisposition.
  • Diet may also be a factor.

Predisposing factors

General

  • Generally seen in mature adult rabbits rather than juveniles.

Specific

  • Certain breeds, in particular spotted rabbits such as the English spot English, appear to be predisposed.

Pathophysiology

  • Not fully elucidated, but histopathology of the gastrointestinal tract often shows lymphocytic/plasmacytic inflammation.
  • Fecal cytology may show long fiber particles together with altered microbiota (comprising a mixture of hard fecal pellets and cecotrophs), which suggests that the hindgut’s function of separating large and small particles is dysfunctional.
  • The cecum may fill and not function properly.
  • Over time, progressive malnutrition leads to signs of cachexia, a distended abdomen and metabolic derangements such as anemia, hypoproteinemia and hypoglobulinemia.
  • Gas and food build-up within the gastrointestinal tract will lead to intermittent bouts of anorexia and pain Gastric dilation and stasis.

Timecourse

  • Seen in mature rabbits.
  • The clinical signs tend to progress slowly over months and sometimes years.

Epidemiology

  • Usually an individual disease problem rather than a group issue (although related individuals may share a predisposition).

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Fontanesi L, Vargiolu M et al (2014) The KIT Gene is associated with the English Spotting Coat Color Locus and congenital megacolon in Checkered Giant rabbits (Oryctolagus cuniculus). PLos One 9 (4), e93750 PubMed.
  • Bodeker, D, Turck O, Loven E, Wieberneit D & Wegner W (1995) Pathophysiological and functional aspects of the megacolon-syndrome of Homozygous Spotted rabbits. J Vet Med Series A 42, 1-10 PubMed.
  • Wieberneit D & Wegner W (1995) Albino rabbits can suffer from megacolon-syndrome when they are homozygous for the “English Spot” gene (EnEn). World Rabbit Sci 3 (1), 19-26 UniPolValencia (pdf download).
  • Flemming K, Kühnel C, Wieberneit D et al (1994) The problems of spotted breeds of rabbits. 4. Morpho-and histometric findings in the CNS and thyroid glands and the hormone content in blood at slaughter of hybrid rabbits, and estimation of the heterosis effect. Deutsche Tierarztliche Wochenschrift 101 (11), 434-439 PubMed.

Other sources of information

  • Stapleton N (2017) Megacolon. In: Rabbiting On. Rabbit Welfare Association & Fund, UK. pp 2-3.
  • Harcourt-Brown F (2014) Digestive System Disease. In: BSAVA Manual of Rabbit Medicine. Eds: Meredith A & Lord B. BSAVA, UK. pp 168-190.