Megacolon is an abnormal increase in the length or diameter of the colon. This condition can be congenital and acquired, but megacolon in children is most often a congenital developmental anomaly. Among the clinical signs of the disease leading is chronic constipation. In the treatment can be used both conservative and operational solutions to the problem.
Causes and types of disease
There are several variants of megacolon, the development of which is provoked by various factors. Modern classification involves the allocation of the following forms of the disease:
- idiopathic, that is, of unknown origin, the action of a specific provoking factor is not established,
- neurogenic occurs as a result of organic damage to the nerve trunks responsible for the innervation of the colon,
- toxic is noted while taking certain medications or ingestion of toxic substances in the body,
- Endocrine is one of the numerous clinical manifestations of a number of hormonal diseases of nature,
- psychogenic develops with neurosis and some other mental illnesses,
- obstructive marked in the case of a mechanical obstacle in the digestive tract or adjacent abdominal organs,
- The agangliotic (or Hirschsprung disease) is a variant of the genetic abnormality in which part of the colon is deprived of innervation, and therefore cannot be properly reduced.
After studying the proposed classification, it becomes clear that the action of some factors can and must be prevented (the penetration of toxic compounds into the child’s body), and some causes (various developmental anomalies) can be eliminated and prevented.
Megacolon in children is a rather rare disease. The most common variant is Hirshprung disease and idiopathic form (together making up about 35% of all cases), obstructive is found in 10% of cases, the frequency of occurrence of psychogenic, endocrine and toxic forms does not exceed 1-2%. Only agangliosis is most typical for boys, the other forms of this disease with the same frequency occur in children of both sexes.
In a child of any age, megacolon is manifested by an expansion of the diameter or an increase in the length of a certain part of the large intestine, as well as a significant thickening of its wall. The longer this area and the farther from the rectum it is, the more severe the course of the disease can be predicted.
An overstretched colon cannot perform the necessary functional load — complete the absorption of nutrients, form fecal masses and remove them naturally. An oversized colon becomes a pathological reservoir for fecal masses. This leads to the development of endogenous intoxication due to fermentation and rotting processes in the intestines of a child.
Clinical symptoms of the disease
The symptoms of megacolon are determined by the localization of the affected area of the colon and its length. In accordance with the anatomical structure of the intestine are distinguished:
- rectal variant (only the rectum or its separate parts are affected),
- rectosigmoid (sigmoid colon is involved in the process),
- segmental (several pathologically extended areas are noted at different levels of the intestine),
- subtotal (expanded almost half of the entire colon),
- total (affected all parts of the colon).
In accordance with the clinical signs of megacolon, 3 degrees of severity (stage) of the disease are distinguished:
- compensated - clinical signs occur only with significant violations of child care, the overall physical and psycho-emotional development is not impaired, with the necessary treatment and correction of lifestyle, the child’s quality of life is high,
- subcompensated - the symptoms of the disease gradually and stubbornly increases, there are initial signs of impaired physical development as a result of progressive disorders of the digestive processes,
- decompensated - the clinical symptoms are constant and not eliminated by conservative treatment, there is a clear impairment of the physical and emotional development of the child, and often complications follow.
The clinical symptoms of megacolon are almost the same in a child of any age, the only difference is that an older child can describe their own feelings in more detail.
Among the most typical signs of the disease are known:
- daily difficulties with emptying a child's first year of life, constipation can last for many days, discharge of gas and feces only after an enema,
- progressive meteorism, which, in fact, causes an increase in the abdomen that does not correspond to the age of the child (the so-called “frog's belly”),
- when pressing on the child's belly, you can find tight loops of the intestine, or the so-called “clay” symptom - in the place of pressure there is a fossa.
In the absence of treatment and pronounced disorders of metabolic processes are noted:
- progressive persistent constipation and flatulence,
- stool heaps and stones
- hypotrophy, the discrepancy between the child’s physical development and age norms,
- anemia (due to impaired vitamin metabolism),
- fecal intoxication, as a result of which a child of any age is constantly inhibited, drowsy, sluggish, poorly assimilates any information.
In the absence of treatment or total intestinal damage, signs of intestinal dysbiosis or intestinal obstruction are noted, which requires additional examination and addressing the need for surgical intervention.
Megacolon can be diagnosed literally in the first days of a child's life, less severe forms of the disease - within the first year of life. Problems of discharge of feces and constant flatulence over the life of a child not only do not disappear, but gradually increase, especially since the introduction of complementary foods and adult food. This problem should not go unnoticed.
Parents should comprehensively examine the child with a violation of the chair, and not postpone the solution to the problem for a later time or expect a spontaneous cure (it simply will not).
General diagnostic rules
The necessary initial examination and the mandatory research complex will be prescribed by a pediatric or family doctor. In the future, you may need to consult narrow specialists: pediatric surgeon, gastroenterologist, endocrinologist.
The complex of studies assigned in such cases most often includes:
- general clinical detailed analysis of peripheral blood and urine,
- biochemical tests reflecting the state and functional usefulness of the liver and kidneys,
- coprogram, planting feces for dysbacteriosis and pathogenic flora,
- colonoscopy and irrigoscopy,
- a review contrast X-ray (with a contrast barium mixture) to assess the localization and extent of the modified part of the colon,
- tomography (positron emission or magnetic resonance) to assess the condition of other organs of the abdominal cavity,
- genetic and histochemical tests to exclude or confirm hereditary diseases and syndromes.
General treatment directions
Radical treatment of any variant of megacolon is one - surgery. It involves the excision of a modified part of the intestine and the subsequent restoration of its integrity. The most appropriate age of the child for surgery 2-3 years, when there are no changes in the physical and psychosomatic plan. With more severe forms of megacolon (total or subtotal) surgical intervention is shown in earlier periods.
Conservative treatment is always preceded by surgical treatment. In some cases, this treatment option will be sufficient for the normal development of the child and the operation can be avoided.
Comprehensive conservative therapy includes:
- dietary food, which contributes to the regular emptying of the intestines, the diet of such a child should contain a sufficient amount of dietary fiber (seasonal fruits and vegetables), cereals (cereals, casseroles), fermented milk products and dried fruits (dried apricots, raisins, prunes),
- daily massage of the abdomen with slight circular movements in a clockwise direction,
- sufficient physical activity and special physiotherapy exercises to strengthen abdominal muscles,
- as any laxatives are contraindicated in this case, it is recommended to include vegetable oil in the diet (2 dessert spoons 3 times a day for children of preschool and school age),
- regular emptying of the intestines of the child should be achieved using various options (hypertonic, cleansing, siphon),
- after successful completion of the enema recommends that you put the vent tube on the baby.
Dr. Komarovsky, like many pediatric doctors, insists on the need for an early examination of a child with suspected megacolon, careful care of a child and only after that - carrying out surgery.
As a preventive measure, it is recommended to have a proper diet and other general issues aimed at preventing the progression of the disease.
Megacolon can be congenital or acquired. The congenital type of the disease is caused by abnormalities of embryonic development, in particular, the nervous apparatus of the intestine. The acquired megacolon is due to severe infectious, oncological, systemic diseases, injuries, including multiple operations that lead to adhesions, as well as the toxic effects of drugs.
For development reasons, the following types are distinguished:
- Hirschsprung's disease - congenital hypoplasia of the nervous apparatus of the colon,
- obstructive, due to mechanical obstacles
- psychogenic, developing on the background of mental disorders,
- neurogenic in diseases of the central nervous system,
- idiopathic, in the absence of a clear root cause of the disease.
The localization of megacolon are forms:
- rectal - the rectum is affected,
- rectosigmoid - direct and part of the sigmoid colon,
- segmental - part of the large intestine,
- subtotal - descending and part of the transverse section of the large intestine,
- total - the entire colon is affected.
Megacolon is chronic, subacute and severe in severity.
The symptoms of megacolon are similar, although the causes may be different. Their severity depends on the prevalence of the process, the severity and the initial state of the patient.
The first and main feature of megacolon is prolonged constipation, from two days to the complete absence of an independent chair for several months. The second sign is flatulence, it may be dimly expressed, or it may be permanent and accompanied by painful sensations. Visually, the abdomen is enlarged, its shape is irregular, you can see a peristaltic wave. In children, a “frog belly” is formed due to flabbiness and weakness of the skin and muscles of the anterior abdominal wall. Perhaps the development of vomiting, which is not associated with food intake. Excrements with a characteristic putrid odor, with impurities in the form of mucus, undigested food fragments or even blood.
In the compensation stage, an independent chair can be adjusted with the help of a diet, in more difficult situations there is no choice and you have to resort to enema. Irregular emptying leads to the so-called fecal intoxication, which children are more susceptible to. Characterized by general exhaustion, loss of appetite and body weight, dizziness, weakness, lethargy, a sharp decrease in efficiency. And against the background of the constant expansion of the digestive organ and meteorism, the excursion of the lungs is limited, the heart assumes a horizontal position.
This leads to the development of respiratory and cardiovascular insufficiency, which manifest as shortness of breath, a bluish skin tone, palpitations, and an increase in the frequency of infectious diseases of the bronchopulmonary system. A complex of changes in the most important systems of the body leads to an inevitable metabolic disturbance, disruption of water and electrolyte balance, the formation of edema. Secondary changes further aggravate the pathological process of the intestinal wall, acute obstruction, perforation, and peritonitis may occur.
In addition to the history of the disease, complaints and symptoms for the diagnosis of this disease resort to instrumental and laboratory research methods.
The first to perform a survey radiographic image of the abdominal cavity. Symptoms of megacolon are swollen intestinal loops, high-standing diaphragm. Next, take a picture with contrast, which allows you to determine the area of the narrowing of the intestine with a pronounced expansion above it. This site is the aganglion zone. According to its localization and volume, the prevalence and localization of the pathological process is judged.
For more accurate diagnosis resort to sigmoidoscopy and colonoscopy. With the help of special equipment, an inspection is made, and it is possible to take the material of the affected part of the digestive organ for histological examination. Anorectal manometry is performed to assess the rectal reflex.
Laboratory methods for the study of megacolon include: a clinical blood test, which can be used to diagnose anemia and detect leukocytosis - an increase in the number of immune cells due to a chronic inflammatory process, stool analysis, usually detect pathological impurities, culture on culture media to detect infection and, a histological examination of a section of the intestine to determine the presence or absence of cells of the nervous tissue in it, which is a decisive diagnostic prognostic for Nacom Hirschsprung's disease.
The type of treatment of megacolon is determined after a detailed diagnosis, with the determination of the cause, localization, prevalence and severity of the disease. It is also important to take into account the age of the patient, the duration of the disease and the current general condition. There are two types of treatment: conservative and operative. For each of them articulated clear testimony. Moreover, conservative therapy is shown as a background in determining indications for surgical intervention.
Conservative therapy is multifaceted and complex, aimed both at eliminating the main causes of megacolon, and at strengthening measures that normalize the general condition of patients.
- Diet, with the use of foods rich in fiber: whole grain cereals, fruits, vegetables.
- Physical therapy, mainly exercises that strengthen the front wall of the abdomen.
- Massage the abdomen. Facilitates the passage of food through the gastrointestinal tract, prevents the formation of food stagnation.
- Electrostimulation. This is a type of physiotherapy, consisting in the influence of electric current, contributing to a more effective reduction of muscle fibers.
- Enemas. They differ in type and volume of content and are: oil, cleaning, hypertonic, siphon. The frequency of application and the type of procedure for delaying the fecal masses of the large intestine is determined by the doctor. In addition to micro enemas with oils, you can take two tablespoons of castor oil three times a day to soften and ease the excretion of feces.
- Sanatorium treatment in specialized institutions.
Means that support and restore the intestinal microflora: Linex, Bifiform, Yogurt. Drugs that increase intestinal motility: Motillium, Domperidone. Enzyme preparations: CREON, Panzinorm. Laxatives for the treatment of large intestine: Guttalaks, Bisadil, Glitselaks. It is important to remember that these drugs are used as a last resort and are not intended for permanent use, due to the inhibition of the rectal reflex. Antibacterial agents. With the development of intestinal infection.
It is the method of choice for Hirschsprung's disease and the obstructive form of megacolon. It consists in excision of the pathologically changed part of the large intestine or removal of the obstruction factor and the formation of a colostomy - removal of the intestine on the anterior abdominal wall. To collect feces use calapriemnik. The second stage of surgical treatment is the restoration of intestinal integrity.
Measures aimed at preventing the development of megacolon are reduced to the regular and full emptying of the large intestine, preventing the development of constipation. This is achieved by good nutrition with a sufficient amount of coarse fiber, moderate physical activity and quitting smoking, alcohol, and drugs.
Мегаколон – тяжелейшая патология толстого кишечника, которая приводит к развитию заболеваний во всем организме. But, with a full-fledged diagnosis and timely initiated complex treatment, the prognosis for curing patients, improving their quality of life and working capacity is favorable.
Not all parents really objectively evaluate what would seem to be typical problems with the chair. In fact, when it comes to megacolon, the lack of treatment entails:
- progressive flatulence
- prolonged constipation
- the formation of fecal debris and stones
- severe intoxication products of fermentation and rotting fecal masses.
If the disease was detected in a timely manner, then deciding what to do when developing further treatment, in most cases, experts prefer conservative therapy. As a rule, this is enough for the child to feel well and develop in accordance with age, both physically and psycho-emotionally. In other cases, the disease must be treated with surgical methods.
What can you do
Wishing to provide high-quality first aid to their child along with doctors, parents can:
- Provide the patient with a balanced diet food.
- Perform an independent massage of the child’s abdomen, making movements in a circle in a clockwise direction.
- Ensure that the child performs the exercises from the complex physical therapy, developed abdominal muscles.
What the doctor does
In order to cure the child by conservative methods, the doctor prescribes the necessary stimulants. The primary task of a specialist is to develop an individual diet, teaching parents to properly perform the necessary procedures for daily bowel movements by a child. If the operation is necessary, the doctor excises the affected segment of the intestine and restores the integrity by stitching. At the age of 2-3 years, the operation is overwhelmingly successful.
What is megacolon?
Megacolon is a pathological condition of the large intestine, in which it is hypertrophied, with the result that a separate section or organ as a whole increases in diameter. The disease is observed among adults and children, in most cases the sigmoid intestine is affected. Pathology can be congenital and acquired character.
With the development of megacolon, the patient has various unpleasant symptoms. In addition, a psychotrauma is being formed, which should not be overlooked in the treatment of a disease.
Depending on the cause that led to the development of such changes in the intestines, the pathology is divided into the following types:
- Hirschsprung disease, or agangliosis. This form is innate. It is characterized by the absence of the nerve plexus in the rectosigmoid, which leads to the cessation of peristalsis in it. During food digestion, the lump reaches this area and cannot move on. Manifestations of the pathological process begin to occur in early childhood.
- Idiopathic. This type of megacolon is diagnosed in cases where the true cause of the disease could not be established.
- Endocrine. It occurs on the background of the work disorders of the endocrine structures: pancreas, thyroid, sex glands, pituitary.
- Psychogenic. This type of megacolon is usually observed in patients with mental disorders.
- Neurogenic. It develops in cases of damage to the nervous structures of the large intestine or in pathologies of the brain or spinal cord.
- Obstructive. This type of pathological condition occurs when there are mechanical obstacles in the intestine that impede the promotion of fecal masses. These can be fistulas, scars, adhesions, consequences of inflammatory processes.
- Toxic. It is considered one of the most dangerous types of megacolon, as it can be fatal. Developed as a result of infectious processes in the cavity of the small intestine, may be complicated by sepsis.
Regardless of the form of megacolon disease requires mandatory treatment. To conduct the necessary therapeutic measures can only specialist.
Various factors can provoke the development of megacolon, but they differ somewhat depending on the origin of the pathological process. Acquired forms often occur as a result of such states:
- the effect of drugs
- intestinal amyloid,
- traumatic damage to the walls of the digestive canal,
- Parkinson's disease,
- lack of thyroid hormones (hypothyroidism),
- the presence of scars, fistulas, collagen diseases in the intestine,
- infectious bowel disease,
- oncological processes.
Factors that influence the process of fetus formation in the period of embryonic growth can provoke the development of an inborn type of the disease. It can be:
- conduction disturbance of nerve impulses
- complete or partial absence of nerve endings responsible for the regulation of the bowels.
In order to conduct the correct treatment of megacolon in an adult or a child, it is necessary to begin with the identification of the root cause of the pathological process.
The severity of megacolon is determined by the prevalence of the pathological process. It depends on this how severe the symptoms will be. In the congenital form, it begins to manifest itself in the first days after birth or after 2-3 months.
These children noted:
- swollen belly,
- no bowel movement for 1-2 weeks
- vomiting, nausea, signs of dehydration (due to intoxication of the body).
In some cases, after prolonged constipation, diarrhea develops. As a rule, emptying of the intestines occurs only after setting siphon enema. On palpation of the anterior abdominal wall, it is possible to detect dense strands of accumulated fecal masses.
For megacolon is characterized by an enlarged abdomen and swollen intestines.
A characteristic symptom of megacolon is the so-called clay symptom: when you press on the affected area, the fossa remains.
However, congenital megacolon can manifest itself not only among children, but also among adults. In such patients, Hirschsprung's disease for a long time is characterized only by persistent constipation. Only by the age of 20-30 may additional symptoms of the disease appear, which help to diagnose and treat.
- Patients suffer from chronic constipation, flatulence, pain. Moreover, the absence of defecation can not be eliminated by adjusting the diet or with the help of drugs. It is possible to release the intestines only after the delivery of an enema or a venting tube. Fecal masses have a fetid odor. They contain elements of undigested food, mucus, and blood.
- The stomach becomes swollen, occasionally vomiting worries, in the masses you can find streaks of bile.
- Due to persistent constipation, toxic substances accumulate in the body, which causes a worsening of the patient’s general condition. Marked by:
- weight loss
- reduced performance
- nausea and vomiting.
- In the absence of timely treatment, the bloated area of the large intestine leads to deformation and displacement of the internal organs. This is manifested in the following:
- impaired lung function, heart,
- the chest becomes barrel-shaped,
- tachycardia, rhythm disturbance, increased respiratory movements,
- increases the risk of pneumonia, bronchitis due to congestion in the lungs.
- The disturbance of metabolic processes develops, the face, limbs become edematous, cyanosis of the skin, anemia is noted.
- On the part of the digestive system may occur:
- fecal peritonitis,
- mucosal perforation,
- acute intestinal failure.
This pathology requires compulsory treatment in the early stages, since the advanced stages can lead to severe complications.
Conservative treatment of megacolon is complex and involves the use of such methods:
- Diet. Correction of nutrition is carried out in order to soften the feces and facilitate their release from the intestine. Patients are encouraged to use foods rich in coarse fiber. You can eat cereal cereals, vegetables, fruits, prunes, dairy products.
- Medications. The following groups of drugs can be used for treatment:
- antibiotics: prescribed in cases where megacolon is accompanied by an infectious process or with the threat of sepsis,
- bacterial preparations: Bifidumbakterin, Bifikol colibacterin,
- Means for improving intestinal motility: Hexal, Domperidone, Motillium, Motilak,
- enzymatic preparations: Pancreatin, Creon, Panzinorm, Pangrol.
- Exercise therapy. Physical therapy in this pathology is aimed at strengthening the muscles of the peritoneum. With megacolon, it is necessary to perform exercises aimed at strengthening the abdominal muscles.
- Massage the abdomen. This method also gives a good result in complex therapy. It is necessary to make slightly pressing movements in a clockwise direction (starting from the area of the stomach). The procedure must be done a quarter of an hour before meals, in order to accelerate the evacuation of fecal masses.
- Enemas. Such procedures are used regularly to facilitate the discharge of fecal masses. What type of enema is needed in a particular case can only be determined by the doctor, taking into account the patient's condition. Different types are applied:
- Electrostimulation. This procedure involves the impact on the affected area of the colon low-frequency currents, which contribute to increased motility and accelerate the evacuation of fecal masses.
- In addition, the doctor may recommend the use of vegetable oil, it will help speed up the process of cleansing the intestine. Adults can drink 30-45 ml three times a day, 15 ml (1 tablespoon) will be enough for children once a day.
Important! In no case can not be used to treat this disease laxatives, since with prolonged use, they lead to the development of intestinal obstruction.
If conservative methods do not give the desired effect, use a surgical way to eliminate the problem. Also, the operation is carried out in case of a congenital form of the disease, children are recommended such an intervention at the age of 2-3 years. It consists in removing the affected part of the intestine.
In the obstructive form of megacolon, the immediate cause of the pathological process, that is, adhesions, scars, narrowed areas, is removed. After excision, both parts of the intestine are stitched together. When there are no contraindications to surgical treatment, during the second operation the wall sections are joined.
In some cases, it is impossible to cut out megacolon in one operation. In such situations, a colostomy is established, and the stool is collected with the help of a calosbornic. If the second stage of the operation cannot be performed, the patient lives with the intestine removed to the side of the peritoneum all his life.
In the postoperative period, patients are prescribed antibacterial and anti-inflammatory drugs, vitamins. Also it is necessary to adhere to the diet, which includes dairy products, food with a high content of coarse fiber: fruits, cereals, vegetables. In addition, during the rehabilitation period the patient undergoes a course of exercise therapy, it is recommended to massage the abdominal wall in order to strengthen the muscles. For 18 months after treatment, patients are at the dispensary account.
Causes of megacolon
If the disease is diagnosed in the neonatal period or in the first year of life, then this condition is regarded as congenital. The reason for the defect of the colon are considered teratogenic factors. These include:
- Stress effects. They are especially unfavorable in the first half of pregnancy when the embryo develops.
- The effects of toxic drugs and chemicals.
- Alcoholism and drug addiction in the future mother.
The cause of congenital megacolon is a violation of the migration of nerve cells in the embryo. As a result, receptor failure occurs, leading to a slowdown or lack of conduction of impulses along the nerve fibers of the digestive tract.
Acquired megacolon can develop at any age. More often he is diagnosed among the child population. One of the background diseases for the occurrence of megacolon is Hirschsprung's disease. This pathological condition is characterized by the lack of innervation of the intestinal area. Similar changes in the work of the digestive system develop with other diseases. Among them:
- Toxic effects on the body. Due to the influence of chemicals, nerve fibers and glands (ganglia) are damaged in the intestine.
- Paresis of the digestive tract. May occur after a stroke, be a symptom of a spinal hernia, etc.
- Systemic pathology of connective tissue.
- Tumors of the brain or spinal cord, peripheral nerves.
- Intestinal amyloidosis.
- Constipation caused by a lack of hormonal activity of the thyroid gland, drugs.
In some cases, it is impossible to establish the cause of organ hypertrophy. At the same time the diagnosis is set: idiopathic megacolon.
The mechanism of development of colon hypertrophy
Because of a violation of the innervation of the colon, its functions are affected. The affected part of the body relaxes. As a result, the formed fecal masses move along the intestine more slowly, or completely stagnate in its lumen. Due to the accumulation of feces, the proximal parts of the body begin to stretch and grow in size. The walls of the enlarged area become thinner, and the muscle tissue in them is exposed to damage. As a result, it is replaced by connective tissue, which normally should not be there. Even after emptying the bowel atony remains. Because of the stagnation of the feces, intoxication often occurs, the damaged part of the intestine becomes inflamed. Fibrosis and edema lead to even greater hypertrophy.
Megacolon in children: symptoms of the disease
The symptoms of the pathological condition in children are most often found by parents. At an early age, the first sign of the disease can be: abandonment of the mother’s chest, crying and sleep disturbance. Later - the specific clinical picture joins. With a congenital defect of the digestive system, the following symptoms are observed:
- The chair at the child does not depart by itself. If the length of the lesion is not large, then constipation occurs. At discharge, fecal masses have a putrid odor, an admixture of mucus.
- Progressive increase in abdominal circumference.
- Pallor of the skin, reduced turgor.
- Slow weight gain.
With prolonged constipation, signs of intoxication develop. The body temperature rises, weakness is observed.
The same symptoms bother children with acquired megacolon. Chronic intestinal hypertrophy leads to flabbiness of muscles and abdominal skin. Due to the constant swelling of the colon, there is a characteristic sign - "frog belly". On examination, peristaltic movements can be seen. Children have meteorism, pain in the lower abdomen, chronic constipation.
Treatment of bowel hypertrophy
If the disease does not lead to acute intestinal obstruction, then it is treated by conservative methods. These include the use of cleansing enemas, abdominal massage and physiotherapy. Also, the prescription of enzyme preparations and agents for enhancing the motility of the gastrointestinal tract (medication “Zerukal”, “Maalox”) is shown. It is important to observe the diet for the prevention of constipation.
In acute megacolon, caused by Hirschsprung's disease, resection of the colon is performed. If there is a total organ damage, resort to installing a colostomy.
Causes and pathogenesis of megacolon
Congenital megacolon is caused by the absence or deficiency of peripheral receptors, impaired conduction along the nerve pathways, which develop as a result of impaired neuronal migration during embryogenesis. The causes of acquired megacolon can be toxic lesions of the nerve plexuses in the colon wall, CNS dysfunction in Parkinson's disease, injuries, tumors, fistulas, cicatricial contractions, drug constipation, collagenosis (scleroderma, etc.), hypothyroidism, intestinal amyloidosis, etc. These factors cause violation of the motor function of the colon in one way or another and the organic narrowing of its lumen.
Violation of innervation or mechanical obstacles impede the passage of fecal masses along the constricted part of the intestine, causing a sharp expansion and increase in the sections located above. Activation of peristalsis and hypertrophy of the upper sections is compensatory and is formed to promote intestinal contents through the aganglionic or stenotic zone. In the future, in the extended section, the hypertrophied muscle fibers die and are replaced by connective tissue, which is accompanied by atony of the altered intestinal section. The progress of intestinal contents slows down, prolonged constipation occurs (there is no stool for 5-7, sometimes 30 days), the urge to defecate is suppressed, slag is absorbed, dysbacteriosis and fecal intoxication develops. Подобные процессы при мегаколоне неизбежно сопровождаются задержкой развития ребенка или резким снижением трудоспособности взрослых.
Therapeutic tactics depend on the clinical course and the form of megacolon. With compensated and subcompensated flow, as well as inorganic forms of megacolon, a conservative approach is taken. Therapy of megacolon includes a diet high in fiber, enemas (cleansing, petrolatum, hypertonic, siphon), abdominal massage, the appointment of bacterial preparations that normalize the intestinal microflora, enzyme preparations, modulators of colon motility, electrostimulation of the rectum.
In case of Hirschsprung's disease, operative treatment is required - performing resection of the aganglionic zone and the enlarged part of the large intestine, which is performed at the age of 2-3 years. In case of obstructive megacolon, an emergency overlay of the colostomy and preparation for radical intervention is required.
The volume of colon resection in megacolone is determined by the extent of the lesion and may include anterior resection of the rectum, abdominal anterior resection with the reduction of the colon, rectosigmoidectomy with the imposition of a colorectal anastomosis, subtotal resection of the colon, with the formation of ileorectal anastomosis, and the iyoungyy; the colostomy is closed.
Treatment of other forms of megacolon is to eliminate the causes - mechanical obstructions (fistulous atresia of the anus, cicatricial stenosis, adhesions), chronic constipation, hypovitaminosis, inflammation of the intestine (colitis, recto sigmoiditis). Further forecast is determined by the form and causes of megacolon, the correct volume and method of operation.
What is megacolon
Megacolon is a malformation of the colon, characterized by gigantism throughout its length or only in certain areas.
Normally, the gut has different diameters throughout. Therefore, it is possible to talk about pathological increase only if these indicators are overcome.
The intestine is considered enlarged if the cecum is larger than 12 cm, the ascending colon and the transverse colon are> 8 cm, the rectosigmoid is> 6.5 cm.
Pathology is found in both adults and children.
Types of disease
To date, there are 7 types of the disease. The division occurs by causative factor. Such a classification is necessary for the proper selection of therapy.
- Hirschsprung disease (congenital megacolon). This is a congenital malformation of the colon, which is clinically manifested by its gigantism. In boys, the disease occurs 3-4 times more often than in girls.
In 1887, Danish pediatrician Harold Hirschsprung drew attention to a strange disease in two boys, which he had not met before. Since the gigantism of the colon was the basis of the pathology, the doctor gave it the name megacolon.
The acquired form of the disease is mainly found in adults, while the congenital (Hirschsprung disease) prevails in children.
Normally, a healthy person has special nerve ganglia in the walls of the organ, which are laid during intrauterine development for a period of 8 to 12 weeks. Their function is to excite the muscle layer, it contributes to the further advancement of food. In Hirschsprung's disease in certain areas or along the entire length of the intestine, these nodes are missing, which leads to stagnation of the contents. Since the motor function is disturbed, constipation becomes permanent, which provokes a pathological increase.
Today, scientists are still unable to determine the exact cause of this congenital pathology. It is suggested that this is due to mutations in the DNA. If the next of kin has this anomaly, then the risk of megacolon in a child increases.
The reasons for the acquired megacolon are:
- thiamine deficiency (vitamin b1),
- intestinal infections
- various obstacles to the fecal masses,
- abdominal trauma,
- lesions of the central nervous system, in which the regulation of the intestine is disturbed.
We should also note the idiopathic form, in which it is not possible to determine the specific cause of the disease.
Symptoms of the disease
The main clinical manifestation of this disease is chronic constipation, which subsequently leads to the following symptoms:
- intestinal obstruction,
Next, develop lesions of the pulmonary and cardiovascular systems against the background of increasing the size of the intestine.
Swollen, loops of the large intestine push aside other organs around them, which leads to the removal of the chest up and the acquisition of the shape of the barrel.
- shortness of breath
- cyanosis (blue),
- heart pains
- frequent inflammation of the bronchi and lung tissue.
For adults, a milder course of the disease or the complete absence of any symptoms is characteristic.
In case of Hirschsprung's disease, surgical intervention is indicated, since conservative therapy is ineffective in these episodes. The resection (removal) of the affected part of the intestine is used in this case.
For the therapy of the acquired form in modern practice using various techniques. They are aimed at eliminating the damaging factor and the prevention of complications.
The goal of the diet is to prevent constipation. It is necessary to give preference to products containing a large amount of fiber - vegetables and fruits. And, on the contrary, to refuse the food leading to fermentation.
It is necessary to include in the diet:
- fresh fruits and vegetables
- dried fruits (dried apricots, prunes),
- vegetable puree (carrot, etc.),
- cereal porridge from gray or brown grains cooked in water (buckwheat, oatmeal),
- steamed meat and fish
- vegetable broths.
It is necessary to refuse:
- fried, smoked, canned products,
- meat, fish and broths based on them,
- spices and spices
- white bread
Various cleansing enemas are used. In practice, hypertonic or siphon enemas are used.
Good performance shows the massage of the anterior abdominal wall. It is aimed at stimulating the work of the intestines. Manipulations should be carried out 10–20 minutes before a meal: from top to bottom clockwise to perform pressing circular movements.