Program Operations Manual System (POMS)
TN 84 (09-25)
DI 23022.233 Megacystis Microcolon Intestinal Hypoperistalsis Syndrome
COMPASSIONATE ALLOWANCES INFORMATION
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MEGACYSTIS MICROCOLON INTESTINAL HYPOPERISTALSIS SYNDROME
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ALTERNATE NAMES
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Berdon Syndrome; Megacystis Microcolon Hypoperistalsis Syndrome; Megacystis Microcolon
Intestinal Hypoperistalsis Hydronephrosis Syndrome; MMIHS; MMIH Syndrome
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DESCRIPTION
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Megacystis
microcolon
intestinal
hypoperistalsis
syndrome (MMIH) is a rare congenital condition characterized by abdominal distension caused by a largely
dilated non-obstructed urinary bladder (megacystis); very small colon (microcolon);
and decreased or absent intestinal movements (intestinal peristalsis). Usual clinical
presentation is similar to other neonatal intestinal obstructions: bile stained vomiting
and failure to pass meconium (the first bowel movement the baby has). Other intestinal
anomalies may be present like intestinal malrotation. Many problems with the urinary
tract result from the bladder dysfunction. It is part of a group of conditions caused
by mutations in the ACTG2 gene, and is inherited in an autosomal dominant manner. However, medical scientists
believe that many cases of MMIH are caused by spontaneous mutations in the ACTG2 gene.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
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Diagnostic
testing: Genetic testing documenting mutation(s) in the ACTG2 gene confirms the diagnosis.
Imaginstudies
and
physical
examination
findings for MMIH show various congenital abnormalities of the digestive tract, including:
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•
Microcolon (very small colon);
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-
•
Decreased or absent intestinal movements;
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•
Abnormalities of the urinary tract including renal dysplasia;
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•
Hydronephrosis (swollen kidneys due to urine buildup);
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•
Enlargement of the ureter;
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•
Undescended testes or bilateral streak gonads (underdeveloped gonads);
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-
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•
Omphalocele (abdominal organs developing outside the belly).
ICD-9: 751.5
ICD-10: Q43.8
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PROGRESSION
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Long-term survival usually requires total parenteral nutrition and urinary catheterization
or diversion. Most long-term survivors have ileostomies. In families with an inherited
MMIH-causing mutation, some family members with a mutation have milder features, living
into adolescence and early adulthood. While there are reports of longer survival,
the prognosis and life expectancy remains poor, and it is still fatal in many cases.
The main causes of death include sepsis, malnutrition, or multiple organ failure.
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TREATMENT
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There is currently no cure for MMIH. Treatment is supportive. Multi-visceral organ
transplantation may be considered.
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SUGGESTED
PROGRAMMATIC
ASSESSMENT*
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Suggested MER for Evaluation:
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•
Clinical history and examination that describes the diagnostic features of the impairment;
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•
Imaging study results (X-ray, magnetic resonance imaging (MRI), computed tomography
(CT) scan); and
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•
Genetic testing confirming diagnosis of the impairment.
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Suggested Listings for Evaluation:
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DETERMINATION
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LISTING
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REMARKS
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Meets
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5.08
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105.07
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105.08
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Equals
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5.07
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or the
listings suggested to evaluate the claim. However, the decision to allow or deny the
claim rests with the adjudicator.
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