Dolichosigma is a congenital pathological elongation of a special part of the large intestine - sigmoid colon.
This condition usually results in a passage disorder feces through the intestines, their long delay in the intestinal lumen and, as a result, to impaired bowel movements and chronic constipation.
In rare cases, the condition of dolichosigma does not manifest itself in any way, and is an accidental finding during examination digestive system.
Dolichosigma is considered as a variant of intestinal development, which in some children and adults leads to the formation of the problem of constipation.
Not all scientists are inclined towards the variant of dolichosigma as an outright pathology; rather, dolichosigma is considered a variant of the intestinal structure, which, under special conditions, leads to problems with stool. Only 25% of children with dolichosigma have problems with stool; the rest of the children grow and develop quite normally.
Anomalies in the structure of the intestine themselves arise as a result of the unfavorable course of the mother’s pregnancy in the first trimester, when the formation of the main structures of the intestine and its parts occurs. For the most part, the presence of dolichosigma is today regarded as a variant of “pre-disease”.
Bowel changes
Scientists closely study the structure of the intestine with dolichosigma, and came to the conclusion that it is disturbed - the phenomena of fibrosis, replacement of normal tissues with connective tissue, swelling, excessive growth of remaining muscle fibers and saturation of the intestinal walls with tissue fluid. All this disrupts the normal functioning of the intestine and its contractions, which help the passage through it. food masses. The full innervation of the intestine is also disrupted, which together gives a predisposition to constipation and cramping pain in the abdomen.
Usually the disease manifests itself in early childhood, parents report persistent problems with stool in the form of constipation, very hard stool or fragmented dry stool.
In addition, the second main complaint with dolichosigma is periodic attacks of spastic pain in the abdomen, especially its lower part along the intestine.
Typically, constipation begins to occur from the moment the child is switched to artificial formula or from the moment complementary foods are introduced; some children develop chronic constipation by the time they move to the common family table from the age of 2-3 years.
In addition to bowel movement disorders, typical manifestations of dolichosigma are:
The child is pale, with an enlarged abdomen against the background of general asthenia and thinness, the tongue is dry and coated with a thick coating, perhaps bad smell from the mouth. Brittle nails and hair, snags in the corners of the mouth, and circles under the eyes are noted.
The course of dolichosigma occurs in three clinical stages:
At the compensated stage, episodic problems with stool occur in almost healthy child, but x-rays reveal elongation of the intestine. There may be attacks of pain in the lower abdomen, but they are rare. The pain is relieved or disappears after enemas and passing stool. The physical development of children does not suffer, the stomach is not painful, and is of normal shape.
In the subcompensated form of dolichosigma, constipation may occur for two to three days, then stool occurs on its own. Constipation is worse and more severe during periods of low fiber intake of fruits and vegetables. Problems with stool and abdominal pain occur almost weekly, flatulence appears, and often the stool does not pass on its own, which prompts parents to resort to enemas. The abdomen may be swollen in the lower half and increased in size.
With decompensation, problems arise daily, stool is retained for up to five days, passes only after enemas, abdominal pain and flatulence are severe, the abdomen is bloated, greatly enlarged in size, physical development is seriously affected.
It is necessary to distinguish dolichosigma from similar Hirschsprung's disease, which is more severe in terms of treatment.
The basis of diagnosis is complaints of persistent constipation and abdominal pain in children since the introduction of a denser diet. The basis for diagnosing dolichosigma is palpation of the abdomen with the definition of the intestine as a dense cord filled with feces, which is expanded and elongated. But accurate diagnosis will only install X-ray examination with a contrast agent. The x-ray will clearly show the shape and size of the intestine, its relative location in abdominal cavity.
Additional research in addition to those described above may include:
If necessary additional research gastroscopy, colonoscopy or sigmoidoscopy is performed, with visual inspection of the intestinal wall.
The basis of treatment is the observation of a surgeon and pediatrician, conservative therapy using rational nutrition and laxative products. Also important is the daily routine and diet, which must be strictly observed without any concessions.
Children are prescribed mild laxatives - duphalac or lactulose. Doses of the drug are selected individually, based on the degree of impairment until the appearance of regular soft stools.
In the hospital, in advanced cases, the following is used:
Surgical treatment dolichosigma is prescribed infrequently, in special cases, when persistent, persistent and prolonged constipation occurs, the expansion of the intestine progresses and persistent damage to its neuromuscular system is revealed.
In these cases, the excess intestinal loops are resected; in the rarest cases, the intestine is completely excised.
In most cases, the prognosis for dolichosigma for life is quite favorable; with growth and development, many disorders are compensated, and the stool becomes independent and complete.
Surgical treatment today is used in exceptional cases.
– an abnormal increase in the length of the sigmoid colon and its mesentery, leading to impaired motility and bowel movement. Dolichosigma is manifested by chronic constipation, flatulence, and recurrent abdominal pain. In the diagnosis of dolichosigma, the main role is played by irrigography and radiography of the passage of barium through the large intestine; auxiliary - rectosigmoidoscopy, colonoscopy, etc. For dolichosigma, diet, massage, exercise therapy, and physiotherapy are prescribed; for prolonged constipation - laxatives and enemas. In case of chronic intestinal obstruction, dolichosigmoid resection is performed.
Dolichosigma is an anomaly in the structure of the sigmoid colon, consisting in its elongation without changing the diameter of the lumen and wall thickness. The elongated sigmoid colon often has increased mobility, which is accompanied by impaired formation and passage of feces. The frequency of dolichosigma in the population reaches 25%, but it is assumed that due to erasure clinical manifestations and the complexity of diagnosis, pathology is not detected in all cases. In pediatrics, dolichosigma is found in 40% of children suffering from constipation.
Normally, in an adult, the length of the sigmoid colon loop is on average 24-46 cm: such a colon is regarded as normosigma. When the length of the sigmoid colon is less than 24 cm, they speak of brachysigma, and when the length is more than 46 cm, they speak of dolichosigma. The combination of elongation of the sigmoid colon with its expansion and thickening of the walls is designated as megadolichosigma.
Dolichosigma can be a congenital or acquired condition in which the sigmoid colon has 2-3 additional loops. The etiological cause of dolichosigma is unclear. It is assumed that congenital disorder growth and fixation of the sigmoid colon may be associated with heredity; exposure to unfavorable environmental, physical, chemical factors; infectious diseases expectant mother, taking certain medications by a pregnant woman.
Acquired dolichosigma occurs as a result of digestive disorders associated with the processes of prolonged fermentation and putrefaction in the intestines. Usually this affects people over 45-50 years of age, leading a sedentary lifestyle, busy sedentary work people who abuse meat and carbohydrates and often experience stress. At the same time, some authors believe that dolichosigma is always congenital anomaly, and digestive problems only cause the manifestation of clinical manifestations given the existing anatomical prerequisites.
Due to long absence bowel movements in a child with dolichosigma, fecal stones may form, fecal autointoxication, anemia, and irritable bowel syndrome may develop. One of the serious complications of dolichosigma is intestinal obstruction due to nodulation, volvulus, kinks, and intussusception of the sigmoid colon. In these cases, a picture develops acute abdomen.
Examination of a child suffering from dolichosigma reveals a lack of body weight, a lag in physical development, pallor of the skin. Palpation of the abdominal cavity reveals intestinal loops filled with feces. A digital rectal examination reveals an empty rectum, even if the child for a long time there was no chair.
Decisive instrumental method in the diagnosis of dolichosigma is irrigography, during which the elongation of the sigmoid colon is detected, the presence additional loops in the form of a “figure eight”, “double-barrel”, “knot”, “snail”, etc. MSCT of the colon allows you to study in detail its location, shape, contours, length, lumen width, haustration, and the presence of additional loops.
To assess the motor-evacuation function of the colon in a patient with dolichosigma, barium passage radiography, electromyography, and sphincterometry are performed. Endoscopy in children (rectosigmoscopy, colonoscopy), ultrasonography of the large intestine, ultrasound of the abdominal cavity, radiography of the abdominal cavity are of auxiliary importance in the diagnosis of dolichosigma. From laboratory methods a coprogram is used; stool analysis for dysbacteriosis, for occult blood, for helminth eggs; clinical and biochemical tests blood.
For spastic pain, antispasmodics (drotaverine, platyphylline) are prescribed; for intestinal hypotension - prozerin, massage of the anterior abdominal wall, exercise therapy, electrical stimulation of the colon, colon hydrotherapy, acupuncture. Patients with dolichosigma benefit from courses of vitamin therapy (B6, B12, C, E), bacterial preparations (probiotics and prebiotics), and treatment in sanatoriums in Zheleznovodsk and Truskavets.
Indications for surgical treatment Dolichosigma occurs extremely rarely in children. Surgical treatment is indicated for intestinal obstruction, failure of conservative therapy, persistent constipation, progressive fecal intoxication, the presence of unstraightened loops and intestinal kinks. With dolichosigma, resection of the sigmoid colon is performed. In case of predominant defeat distal section sigmoid colon, the operation of choice is proctosigmoidectomy.
Usually, if all medical recommendations are followed, it is possible to achieve regular independent bowel movements and an acceptable quality of life. As the child grows, many disorders can be compensated; in some cases, the problem of dolichosigma worries patients even in adulthood. In the latter case, lifelong adherence to the diet and quality of nutrition is necessary, to exclude the development of nutritional, psychogenic and other types of constipation. Children with dolichosigma need pediatrician supervision, pediatric gastroenterologist, undergoing periodic courses of conservative therapy, examining the condition of the large intestine.
Digestive system small child, due to its immaturity, may experience certain disruptions in its work. This manifests itself in various kinds of problems, in particular, bowel dysfunction(constipation).
Constipation in young children is a phenomenon quite common, they happen even with minor changes in the diet (replacement, change in the diet of a nursing mother).
If constipation occurs on a regular basis, this can lead to the development of such pathological conditions, like dolichosigma intestines.
This phenomenon occurs approximately in 40% of children younger age . We will talk about the symptoms and treatment of intestinal dolichosigma in a child in the article.
Dolichosigma intestines is change in the length of the sigmoid part of the organ, and the thickness of its walls and the size of the lumen remain unchanged.
Depending on the clinical manifestations, this phenomenon is not always considered a pathology.
If the child does not experience pain or any discomfort, lengthening the sigmoid intestine can be considered simply its peculiarity. If the baby feels pain and malaise, we are talking about a pathological phenomenon.
When the sigmoid intestine lengthens, the mobility of the organ increases, which leads to impaired intestinal motility and causes certain problems with the movement of feces. One of the main signs of the disease develops - constipation.
How does Hirschsprung's disease manifest in children? Find out about this from ours.
Depending on why the disease occurred, it is customary to distinguish 2 forms: congenital and acquired. Congenital dolichosigma occurs during prenatal period fetal development, when abnormalities in the formation of the child’s intestines occur.
Acquired the form appears when several new loops form in the intestine. This is due, in most cases, to poor nutrition baby, a violation of the digestive process, when rotting and fermentation of food occurs in the intestines.
There is an opinion that there is no acquired form of pathology, the disease manifests itself in all children from birth, but occurs in a latent form and does not manifest itself in any way.
Poor nutrition of a child leads to the development of pathology and the appearance of symptoms. However, this statement has not been proven.
They also highlight several stages of development diseases.
|
Stage |
Features |
|
Compensated |
Constipation in a child occurs periodically, with intervals of several days. The maximum duration of constipation is 4-5 days. The patient feels discomfort in the abdominal area, but otherwise his health remains normal. To eliminate periodic constipation, it is necessary to use enemas and take laxatives. |
|
Subcompensated |
Constipation at this stage occurs more often and lasts longer. The child feels severe pain, bloating appears, increased gas formation. Taking laxatives does not give the desired effect. |
|
Decompensated |
The painful sensations are constant. Feces are retained in the intestines, causing them to swell and increase in size. Intoxication of the body gradually develops. Appear characteristic symptoms, such as the appearance of ulcers on the skin, significant malaise, lack of appetite, nausea and vomiting. |
Main reason, contributing to the emergence and development of pathology has not been identified to date.
However, installed row negative factors, negatively affecting the condition of the intestines, which can lead to the occurrence of dolichosigma.
These factors include:
A child suffering from intestinal dolichosigma experiences the following manifestations of the disease:
Due to the fact that the disease does not always manifest itself severe symptoms , special diagnostic methods, allowing you to accurately determine the presence of pathology.
You will find information on the treatment of diarrhea in a child on our website.
Depending on the clinical manifestations, stage of development of the pathology, characteristics of the body little patient, appoint conservative or radical treatment of dolichosigma.
Non-surgical methods therapies may vary.
First of all, dietary correction is indicated.
There are basic rules regarding eating and choosing appropriate foods:
There are products that it is forbidden to give to a child suffering from dolichosigma. These products include:
But the consumption of fruits, vegetables, lean fish, dairy and fermented milk products, on the contrary, is welcome.
To achieve as soon as possible therapeutic effect In addition to diet, the child is also prescribed other treatment methods.
In some cases, the child surgery is prescribed.
This is necessary in such circumstances as:
The operation is being carried out under general anesthesia , volumes surgical intervention may be different, depending on the age and characteristics of the child’s body, the stage and manifestations of the disease.
Pediatric doctor E. O. Komarovsky believes that first of all, it is necessary to pay attention to general condition child during constipation. If the baby feels well and has no complaints, then there is no need to worry.
You can give your child a laxative (allowed for his age), as well as lightly adjust your diet baby.
If constipation is accompanied by severe painful sensations, it is necessary to show the child to a pediatrician.
In order to prevent the onset of the disease or its recurrence, the following rules must be adhered to:
Dolichosigma is a disease that has very unpleasant symptoms , depending on the stage of its development.
The pathology requires treatment, which consists of following a specially designed diet, taking medications, use of other treatment methods.
In some cases, when the child's condition worsens significantly, surgical treatment is indicated.
Diet for constipation in children from 1 year to 7 years in this video:
We kindly ask you not to self-medicate. Make an appointment with a doctor!
Constant constipation and accumulation of intestinal gases may be caused not by illness, but by the abnormal structure of internal organs. This is how intestinal dolichosigma manifests itself. Doctors know ways to alleviate the condition. But they wait for the patient without treatment serious complications With sharp deterioration health.
Dolichosigma is the abnormal structure of the sigmoid part. This is the last section of the intestine that ends in the large intestine. An anomaly is defined as an elongation or increase in the diameter of the intestinal lumen. IN in good condition in an adult, the length of this section is approximately 24 to 46 cm. With dolichosigma, there are 2 or 3 additional loops. They can twist, fold in layers, and bend. By doing this, they interfere with the full passage of feces and intestinal gases.
According to medical statistics, every fourth person has such deviations in the structure of the intestines. Although the indicators should be higher, the difficulty of detecting the disease does not make it possible to accurately determine the disease in all cases. In children, the disease is registered in 40% of cases with problems with constipation.
There are congenital and acquired forms of the disease. Doctors have not come to a clear conclusion about the time of onset of the disease. The first wave of diagnoses occurs at birth, the second after 45 years. It is possible that people live their entire lives with an abnormal intestinal structure without knowing it. Only with the beginning age-related changes in the digestive system, symptoms of congenital dolichosigma begin to appear again.
Congenital
Acquired
The development of this disease is not associated with infection or inflammation. The impetus for the beginning may be the process of prolonged fermentation or rotting in the intestines.
The disorder, which usually begins in childhood, gradually leads to changes in the functioning of other organs. Failures in the digestive system and other problems begin. When the movement of feces is delayed and intestinal gases accumulate, dysbacteriosis and other abnormalities in digestion begin. Common accompaniments of the disease are gastritis, gastroduodenitis, and other digestive problems.
Constant pain, frequent bloating, increased gas production keeps a person tense and reduces the overall tone of the body. All this quickly leads to the development of stress. This condition is a predisposing factor in the development of gastritis.
Immunodeficiency occurs due to the inability normal operation intestines. Gradually, all sorts of infections begin to appear, and the body cannot cope with them. Symptoms of intestinal problems are manifested by specific rashes on the skin.
In children, pancreatitis, colitis, biliary dyskinesia, and disturbances in the functioning of other parts of the digestive system are additionally detected. In adults, the disease is associated with varicose veins, haemorrhoids.
Symptoms of abnormal intestinal structure may be mild. A sick person may not even notice them. In some cases, the disease is accidentally discovered during diagnostic testing for another reason.
One of the signs of lengthening of the intestinal tract will be abdominal pain. The patient cannot indicate the location painful sensation– it hurts everywhere, in the whole stomach. The more defecation has passed, the stronger the feeling of pain. Dolichosigma of the intestine in adults is accompanied by pain around the navel and in the left iliac region.
Main symptoms:
Black color of stool indicates bleeding in the intestines. In this case, you should urgently seek medical help.
During the initial examination of the child, the doctor notes pale skin, general lethargy, low weight, developmental delay. Palpation of the abdomen reveals distended intestinal loops filled with feces. The rectal method shows an empty rectum - the body is not ready for emptying even with excess feces.
Irrigography has proven to be a good method. This is a method of radiographic examination using contrast, which allows you to view all parts of the intestine of interest. Computed tomography helps to consider additional loops in detail. The device will show the thickness, diameter of the lumen, location, shape, and many other necessary parameters.
An ultrasound examination will allow you to examine the formed loops and possible enlarged areas. During a colonoscopy, the inner surface layer is examined using a flexible probe. If necessary, material will be collected for further examination. They examine blood and feces, identifying infection and inflammation.
When diagnosing intestinal dolichosigma in a child, it is necessary to exclude chronic appendicitis, entenitis, and agangliasis. These pathologies have similar symptoms.
Abnormal intestinal structure begins to be treated therapeutic ways, in special cases they resort to surgical intervention. Drug treatment in adults includes laxatives to empty the intestines, vitamins to maintain the body, special means to reduce the formation of intestinal gases. At severe pain painkillers are prescribed.
Usually the patient is prescribed enemas, but with frequent use, the intestines stop emptying on their own naturally. You need to be careful when using enemas. Do not exceed the amount recommended by your doctor.
Electrical stimulation of the colon successfully restores motility. It is also recommended to physical activity, special massage anterior abdominal wall. Effective method is a colon hydrotherapy procedure - this is a cleansing that is carried out using a specialized apparatus. The intestines are washed with water with the addition of mineral solutions, medicinal herbs or microflora.
An important addition conservative treatment is dietary food. It must be filling to make up for the lack useful substances. Products should stimulate motor skills whenever possible.
Rules for eating with dolichosigma:
Foods rich in fiber can be harmful when treating an adult. In a diseased intestine may already begin inflammatory processes, in which such food will cause an exacerbation. This issue is resolved during diagnosis. Treatment should only be prescribed by a doctor; self-medication is dangerous.
In some cases, surgical intervention is indicated. It is usually performed in adult patients.
Reasons for the operation:
During the operation, additional loops are removed, blood supply and normal motility of other parts are restored. Surgery is performed under general anesthesia. Medical technology, modern devices allow you to avoid complications.
If treatment or surgery is delayed, this disease leads to dangerous consequences. One of the serious complications is perforation, that is, a through hole in the intestinal wall. Everything that is in the intestine at this moment will penetrate into the peritoneum. This leads to infection if timely assistance is not provided.
This is followed by peritonitis, which is very difficult to fight. Pus strikes internal organs, some have to be removed to save a person’s life. Subsequently, this introduces certain difficulties into the functioning of the body.
A big problem is fecal stones - compressed feces. They have a sharp unpleasant odor, torment the patient with pain, lead to acute obstruction, being a consequence of untimely treatment of this disease.
Another complication is purulent lesions on the skin. They appear as a result of action toxic substances from rotting intestinal stool. Skin ulcers are a breeding ground for any other pathogenic microorganisms that colonize there. On skin persistent cosmetic defect having an unpleasant aroma.
In structure digestive diseases cases of pathology of the large intestine are not in last place. Besides functional disorders intestines, some inflammatory conditions also attract attention. On the radiograph, with dolichosigma, the formation of the “two- or three-barreled gun” symptom occurs. The intestines have high mobility in the abdominal cavity.
Dolichosigma in children This is a disease that can also occur in healthy babies in 15% of all cases. Revealed this pathology at the same time, it is completely unexpected and does not cause any symptoms or inconveniences, which allows us to talk about it as a variant of the physiological norm.
Despite this, most children suffer from unpleasant manifestations of dolichosigma. A rather pathognomonic symptom complex is formed:
Many patients experience dyskinesia biliary tract, chronic gastroduodenitis, reactive pancreatitis, etc. If the child’s parents apply late, they may develop irreversible changes in the intestinal structure in the presence of functional disorders.
In order to correctly diagnose and carry out dolichosigma treatment, first it is worth differentiating it from extraintestinal diseases and diseases of an organic nature.
In the treatment of dolichosigma, conservative therapy can be used, and it is often used surgery. Treatment methods and options depend entirely on the patient's condition and the extent of the disease.
Thus, accurate diagnosis of the disease is very important for prescribing correct and adequate therapy.
The purpose of the study was to study methods for diagnosing dolichosigma and chronic constipation associated with it in children of different ages.
The study included 76 children with constipation of varying severity, which appeared against the background of dolichosigma. There were approximately equal numbers of boys and girls. The age of the children ranged from 2 to 14 years.
The algorithm for conducting examinations of children was as follows:
During the study, children were divided into 3 groups:
X-rays were performed on absolutely all patients in order to determine changes in the structure and anatomical and physiological state of the intestine. The contrasting mass allows you to accurately determine all the features.
With a disease such as dolichosigma in children In half of the cases, additional intestinal loops were found, and in the other half, the sigmoid colon was not completely emptied. In 48% of patients, the contrast agent remained in the intestines for a long time.
This method of irrigography can be used in all children, but the radiation dose must be proportionate. This technique allows you to see the structure of the intestines, its functional state, sizes. It is not always possible to understand changes in the mucous membrane and identify complications.
This study was highly informative, since in 72 patients with chronic constipation the diagnosis of dolichosigma was confirmed.
53 children underwent ultrasound of the large intestine. Before the manipulation, the colon was filled saline solution sodium chloride. Antispasmodics were not used. Ultrasound can reveal the location of the intestine, changes in its structure, the nature of peristalsis and tone. At the same time, the kidneys, pancreas, liver and gallbladder. Degenerative changes sigmoid colon were identified in 53 people:
In 28% of children, multiple organ disorders were detected using ultrasound. Therefore, it is worth recognizing as a fait accompli the need to use ultrasound for chronic constipation in children to detect dolichosigma on early stages development.
In order to study the neuro-reflex activity of the sphincter, sphincterometry was performed on 26 children. At the same time, the anorectal reflex was reduced in 7 patients, and its preservation was observed in 19.
Sphinctometry data were compared with clinical data. It turned out that in children with uncomplicated chronic constipation, the internal sphincter is in a state of contraction, and in patients with persistent constipation, there is an increase in the tone of the external sphincter.
Due to the tone of the external sphincter, the tone of the internal sphincter increases and therefore there is no spontaneous act of defecation.
If there are phenomena of encopresis, the tone of both sphincters is reduced and then we see stool. With increasing duration of the disease, there is always a decrease in sphincter tone. This indicates secondary changes in the obturator system of the rectum in young patients with chronic constipation.
It was not possible to clearly formulate a diagnosis after these studies, since they all had different results. In addition, when using functional techniques, the limiting factor for its use is the age of the child; it is in connection with this that the information received may be unreliable.
In 40% of children with chronic constipation, bacteriological examination stool before and after treatment. In children with pathology of the large intestine in the form of dolichosigma, opportunistic flora, and this indicates a malfunction local immunity, which is represented by endogenous anaerobic microorganisms. This proves that children with dolichosigma have dysbiotic changes in the large intestine.
Thus, when chronic constipation develops in children, it is necessary to restore the intestinal microflora.
Coprostasis can cause changes in the structure of the mucous membrane, however, these changes can occur as a result of existing constipation. In order to identify changes in the colon mucosa, 15 patients underwent colonoscopy. Among these children, there were also those whose diagnosis could not be identified after irrigography.
In almost all examined patients, changes in the mucous membrane in the form of colitis were found.
Histological examination of the large intestine
