Brown bowel syndrome: an unusual cause of massive dilatation of the colon.

We report a case of the brown bowel syndrome presenting as major dilatation of the colon which resembled 'toxic dilatation' and necessitated subtotal colectomy. We confirm the reported association between the brown bowel syndrome, malabsorption, and hypovitaminosis E. Furthermore we document failure of the brown pigmentation to resolve after six months in spite of vitamin E supplements and correction of the malabsorption. Finally we suggest that, although the brown bowel syndrome is rare, it should be considered in cases of major colonic dilatation where the patient is or may be suffering from a malabsorption syndrome, and where the sigmoidoscopic appearances do not suggest severe inflammatory bowel disease.