Acta Radiologica

ISSN: 0001-6926 (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/iaro20

The Capacity of the Large Intestine

Olle Olsson

To cite this article: Olle Olsson (1952) The Capacity of the Large Intestine, Acta Radiologica,
37:3-4, 348-355, DOI: 10.3109/00016925209139890

To link to this article: https://doi.org/10.3109/00016925209139890

Published online: 14 Dec 2010.

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 FROM THE ROENTGEN-DIAGNOSTIC DEPARTMENT (DIRECTOR : OLLE OLSFOK) OF THE
UNIVERSITY CLINICS OF LUND, SWEDEN

The anatomy of the large intestine varies n-iddy. These variations,

particularly as to length and disposition in the abdomen have received
much attention. Some authors have claimed that an etiologic relation-
ship exists between certain symptoms and irregularities or abnormalities
seen. This is evidenced, for example, by such terms as dolichocolon
and redundancy of the colon. Numerous papers witness the attempts
made to give clinical significance to this wide range of variations.
Like the stomach, the large intestine serves to a certain extent as a
reservoir in the digestive process. Broadly speaking, the proximal half
of the large bowel may be regarded as an absorptive organ, the distal
half as an organ of defecation. During the t wo phases of digestion repre-
sented by these functions, each half acts as a reservoir, the right half
for the storage of ingesta passed on for further absorption from the
small intestine, the left half for the storage of waste products pending
discharge. Viewed from this angle, the capacity of the large bowel is of
anatomical and functional significance. Prom a clinical point of view
this significance is accentuated by the fact that certain pathologic
processes are accompanied by a disturbance of the storage capacity
of the large bowel. It is therefore remarkable that the study of the
capacity of the large bowel should have been outshadowed to such a
degree by observations of other anatomic features of this organ. This
neglect is still more remarkable in the light of the fact that the capacity
of the large gut may be readily determined under simple conditions by
measuring the amount of contrast fluid employed for the opaque enema
in the ordinary roentgen examination of the large intestine.
~

Submitted for publication, N o r . 1 . 1951.

 THE CAPACITY OF THE LARGE INTESTIXE 349

Earlier Studies of the Capacity of the Large Intestine

-1number of isolated and more or less exact figures of the quantity
of contrast fluid necessary to fill the large gut satisfactorily for roentgen
purposes are available in the literature on megacolon. Reports of sys-
tematic studies of the capacity of the large bowel are, however, scanty.
In a postmortem investigation carried out on soldiers, BROSCH (1912)
found tlie capacity to range from 1,500 cc. t o 2,500 cc. and rarely to
exceed 4,600 cc.
DRUMMOND (1914) studied a few cases postmortem and reported
a capacity of 2-2.5 pints (about 1-1.5 litres). He also observed that
for a rectally injected fluid to reach the caecum, it was necessary to
employ about 800 cc.-1,100 cc.
In a paper on the pressure conditions prevalent in the large gut,
JOLTRAIS, BAUFLE& COOPE (1920) stated that 1,500 cc. fluid is always
sufficient to fil1 the organ. In a textbook description of the large bowel
B o c ~ r s& Coll. (1947) write ))The amount necessary to fill the colon
varies greatly in otherwise normal subjects. The average is about 36
ounces (1,065 c c . ) . ~
J~EYE R
(1932) was the only researcher t o study the question in a large
series of cases. One hundred hospital patients chosen a t random were
given ordinary water enemata. The application pressure, which was
gentle. was not removed until the patient reported a feeling of tenesmus.
In 45 of the patients the sufficiency of the ileocaecal valve was checked
roentgenographically. In all except one, the degree of sufficiency was
considered satisfactory for the measurement of the capacity of the large
gut. The capacity measured was usually 1,600 cc.-2,500 cc. in women
and 2.500 cc.--3,000 cc. in men. These figures must, however, be ac-
cepted with reserve because tlie exarniiiatioii technique, as apparent
rom the brief description, was fairly crude.
It d l be obvious from the above that our knowledge of the capac-
ity of the large intestine is imperfect. 111 the belief that an elucidation
of the question would be of definite value, the capacity of the large
bowel of a number of patients was, some years ago, determined in as-
sociation with the roentgenologic examination of the colon.

Ant 11or’s Series

The ca.pacity of the large bowel was determilied in 360 adult patients
of -\?-horn 148 were men and 202, women. The patients’ ages ranged
from 19 to 85 years; 126 of the patients were not more than 50 years
of age. All the subjects examined were hospital patients. The study
was thus not carried out on ))normals))in the restricted sense of the word.
350 OLLE OLSSON

The present series was selected from those patients referred to our
department for roentgen examination of the colon. Physicians in the
other departments were requested to refer patients to our department
for tlye slightest indications so that it might be possible t o collect a
series of ))normals)).Even in the absence of such a request the range
of general indications must be kept wide on account of the vagueness
of symptoms as, for instance, in cancer of the colon.
I n the present study the ))normals))consisted of a selection of patients
without symptoms of colonic disease. These patients had been referred
t o the department on account of general symptoms such as anaemia,
loss of weight, loss of appetite, etc. Another group of patients were
suffering from diseases (cholelithiasis, spondylosis deformans, etc.)
accounting for their symptoms but not excluding the co-existence of
other causal factors. Pinally there were also a number of patients with
diffuse abdominal symptoms not necessarily colonic in nature. ,411 tliese
three subgroups were referred to our department on account of such
a wide range of indications that the subjects selected for inclusion in
the present series were practically ))normal)).The first group coiiiprised
121 patients.
A second group consisted of 178 patients with varying and often
only slight constipation; only a few of these patients were referred to
the roentgen department on account of constipation; the majoritV be-
longed to the aforementioned subgroups; they have been separat6d off
here as there had been a history of constipation.
Finally there was a small group of 51 patients that had sought relief
for diarrhoea, transient or persistent, recent or long-standing and of
varying degree.
All patients with stenosis due to tumour, inflammation or other
pathologic process were excluded. None of the patients included had
signs of abdominal tumours or constrictive processes originating in or
encroaching upon the bowel.
The history, especially as regards defecation, was taken of all of
the patients included in the present series. Furthermore, only patients
with ordinary dietetic habits were accepted.

E:samination Technique
The usual technique was applied, i . e . opaque enema iinder fluoro-
scopic control, and radiography. The contrast fluid was administered
with the aid of a can devised by HELLMER (1939). The device mas now
complemented with a meter, consisting of a spring balance from which
t,he can was suspended (Figs. 1 a and b). The scale mas graduated in
such a manner that 1 em. on the scale corresponds to litre contrast
 THE CAPACITY OF THE LARGE INTERTISE 35 L

fluid. The can was always suspended at a con-

stant level corresponding t o a n application
pressure of 0 . 7 5 m.; this was fairly constant
throughout the administration because the
falling level of the fluid was compensated by
a corresponding automatic rise in tlie level of
the can itself.
The contrast fluid m s prepared in a uni-
form manner and was of one and the same
specific weight throughout the investigation.
The temperature of the contrast fluid was
niaintained at a constant temperature of 38"
b y means of a thermostat. Continuous rota-
tion by a n electric uniter prevented sedimen-
tation.
All of the patients were prepared for ex-
amination in the same manner, namely b y
nieans of castor oil in the morning, and a
water enema in t h e evening of the day before
the examination and a second water enema on
the morning of the examination.
The contrast fluid was administered in the
usual way, i. e. rather gently and under fluo-
roscopic observation. As soon as the fluid had
reached the caecal pole the weight was read.
At this stage t h e fluid usually began t o pass Fig. 1 . Coiitairict suspnltl-
into the small intestine. In some cases, however, ed froin a >prillg balaucr.
the ileocaecal valve tolerated so much pressure
t h a t up t o 1 litre could be administered after
the fluid had reached the caecal pole; the ordinary filling and not the
maximal filling was registered. Thus, the term ))capacitn of the large
intestine as used here 1s t o be understood as the capachy assessed in
the manner described above.
Repeated examinations of tlie same patient but by different examiners
produced practicaIly equal values.
After being examined horizontally the patient was screened in the
erect position in order t o control the extent t o which the bowel liatl
been filled. If the filling is incomplete the intestinal gas will be entrap-
ped in the flexures, where it is easily recognized. Patients in whoni this
check showed t h e filling t o be incomplete were excluded as were those
in whom the gut had not been completely voided before examination
and therefore still contained scybala. The control of tlie first factor,
the degree of filling in the erect position often revealed small accuniula-
332 OLLE O L S O N

tions of gas in the flexures. In some cases the accumulations were large
and therefore suggested that the filling was inadequate. These patients
were excluded from the series. This point is worth remembering and
emphasizes the necessity of careful palpation of the various sections of
the large bowel during fluoroscopy and also of an examination of the
patient in different postures.
Results
The quantity of opaque fluid necessary for filling the large bowel
was recorded and the sex noted. Entries were made not only of the
))normals))but also of patients with diarrhoea and with constipation.
I n an endeavour to find a norm for evaluating the capacity of the
colon, the amount of opaque solution administered was compared in
every case with the height and surface area of the patient; no certain
relationship was found.
I n view of the known tendency to constipation and decreasing tonus
of the smooth muscle with advancing age, the size of the large gut of
elderly people was compared with that of younger individuals; no definite
difference was observed.
The capacity measured in every case was therefore recorded as an
absolute quantity.
The diagram shows that the deviation of the cases in every group
is very large. Among the normals the quantity necessary to fill the
colon varied between 0 . 6 and 3.0 litres, the average being 1 . 4 5 litres.
I n the constipated group the corresponding figures were 0.7 and 3.9
litres with an average of 1 . 7 4 .
Among the patients with diarrhoea the values recorded varied be-
tween 0.4 and 2.5 litres with an average of 1.38 litres.
The average capacity of the bowel in the normal males was 1.50
litres; in the normal females it was 1 . 4 0 litres. The corresponding figures
for the constipated group were 1 . 9 and 1 . 5 7 respectively. Neither in
the constipated group nor in the normal group did the sexes differ as
regards the average capacity of the large bowel. The statistical differ-
ences observed were not greater than once the standard deviation. Nor
was there any such difference between the normal group and the con-
stipated group. The greatest difference was found between the men in
the normal group and those in the constipated group, but even there
it was not significant.
The number of colonic examinations indicated by diarrhoea, was too
small to permit of statistical analysis. It will be readily seen from the
table, however, that the lowest values of the entire series are in this
group, which as whole shows a shift t o the left. The lowest values were
found in patients with serious ulcerative colitis.
 THE C A P A C I T Y OF THE LARGE INTESTINE 353

N
60 + 61
r o

1
20 25
- 30 Capaclly in 'ilers

aEmL
3.0 35 Capacrly In liiers

'OI

05 I.o
Diagram sliowiiig the iiumber of patients aiid the capacity (litres) of the large bowel
in the ))normal))group (N), in the constipated group (C) a i d in those with diarrhoea (I).
The columns representing the males a n d the females are superimposed.
354

a. b.
Fig. 2 . The two extremes in the constipated group.
‘7) inan with slight constipation and a large bowel capacity of 3 . i ~litye,.
11) woman with moderate constipatioii and a corresponding capacity of 0. i litit,,

The study showed t o what a great extent the capacity of the large
bowel varies from one person t o another. It also showed that the clinical
interpretation of the capacity recorded must be made on the merits of
each case separately. A knowledge of the capacity of the large bowel
inust be valuable t o the clinician for several reasons.
The roentgenologist’s report of the capacity of the bowel enables
the clinician to form a much niorc definite opinion of the anatomy of
the organ than does N general description of its length, thickness and
tortuou mess.
In the treatment of a patient for constipation it must also be of
clinical importance t o know the capacity of the large gut. The two
extremes in the present series were a young man with slight constipation
and a large bowel capacity of 3 . i S litres (Pig. 2 a ) and a woinaii with
moderate constipation aiid a corresponding capacity of 0. i litre (Fig.
2 b). That these differences indicate different types of treatnieiit is
obvious, although i t should not he necessary t o resort t o extremes t o
exemplify the statement.
 THE ('APACITP OF THE LARGE IBTESTIBE 355
In the treatment of colitis knowledge of the quantity of opaque
-fluid necessary to fill the large bowel is useful in estimating the degree
of the change and thereby provide a valuable complement t o the general
clinical picture. In the conservative treatment of ulcerative colitis a
possible cliange in the capacity of the bowel will undoubtedly be of
value in judging the results of' treatment.
In the diagnosis of megacolon knoidedge of the capacity of the
large b o w l will also serve to complement the radiologist's report. Here,
too, it might be of interest to check the capacity for possible change5
during the treatment of tlie condition.
I Iic. clinical value of such roentgeiiologic information may be dis-
r i

cnsietl froni several poiiits of view, but the present series was too small
t o Jvarrant further considerations. The purpose of this study is to stirn-
d a t e the registration and clinical utilization of information easily
obtainable during the routine examinations of the large intestine.
S U Rlbl A R Y
111 association u ith contrast rnrnia
'l'lic ccipdcitv of the ldipe bowel was nieasuied
The anioiint of contrast fluid rieceiidry for filling tlie organ %as tletei-
e\;iitiiiiztiotis
m i n d The values obtainetl are tabulated and di'xusicd.

Z U S A M M E N F A S SU N G
ungsvcrniiigen iles Dickdamies hei riintgcnolo~isclieii Kontrastunter-
scs Darmabschnittes wurde besDirniiit. Die Menpe Koiitrastflussi~keit.
die ziir I-dligen Ausfullung des 1)ickdarnies riijbip war> wurde ermittelt. Die Werte wurden
ig aufgestellt und diskutiert.

RESUJIE
l,n c a p e i t 6 du gros intestin a 6th niesur& au cours d'exaniens par lax-enient
opaque. La quailtit6 de licluicle opaque ndcesstaire pour reniplir l'organe est dEterniinEe.
Les chiffres obtenus sont classds e t discutds.

REFERESCES
BOCK^\. H. & Coll.: Gastro-enterology, Second Edition. W. 8 . Saunders Co., Phil. &
Lolitloll 1947.
BROVX,A: Zur Kerintnis der Dickdarrrikapazitat. W e n . med. Wchschr. 36 (1912), 23%.
1)arxm)sn.H.: Observations on the functions of the colon with special reference t o the
nio\-ements of enemata. Brit. M. J. I (1914); 240.
HEI,L\IEK. H.: Riintgenundersiikilinfi a\' akuta bnk- och njurfall. (Swedish.) Nord. med. 3
(1939); 2891.
J o L ' r R A 4 1 s , E., BATTFLE, P. & COOPE, R.: Essai t i e la mesure de pression du gros intestin.
Arch. d. i p l . de l'ayp. digestif 10 (1920), 618.
ME).ER: 0.: Uber die Capazitat des Dickdarins. 1naug.-Diss. Verlag Franz Pietzcker,
Tiihingen 1932.