Dolichosigmoid is a congenital pathological lengthening of a special part of the large intestine – the sigmoid colon.
This condition usually leads to a violation of the passage of fecal masses through the intestines, their prolonged delay in the intestinal lumen and, as a result, to a violation of defecation and chronic constipation .
In rare cases, the state of dolichosigmoid does not manifest itself, and is an accidental finding during examination of the 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 tend to dolichosigmo as a frank pathology, rather dolichosigmo is considered a variant of the intestinal structure, which under special conditions leads to problems with the chair. Only 25% of children with dolichosigmoid have problems with the chair, the rest of the children grow and develop normally.
Anomalies of the intestinal structure themselves arise as a result of an unfavorable course of the mother’s pregnancy in the first trimester, when the basic structures of the intestine and its sections are laid. For the most part, the presence of dolichosigma today is regarded as a “pre-disease” option.
Scientists are closely studying the structure of the intestine with dolichosigma , and came to the conclusion that it is broken – mainly fibrosis, the replacement of normal tissues with connective tissue, puffiness, excessive growth of the remaining muscle fibers and the soaking of the intestinal walls with tissue fluidpredominate . All this disrupts the normal functioning of the intestine and its contraction, helping the passage of food masses through it. Also, complete innervation of the intestine is disturbed, which all together gives a predisposition to constipation and spastic abdominal pains.
Usually the disease manifests itself in early childhood, parents note persistent problems with the chair in the form of constipation, very tight stools or fragmented dry stools.
In addition, recurrent bouts of pain of a spastic nature in the abdomen, especially the lower part along the intestine, become the second main complaint in dolichosigmoid pain.
Usually, constipation begins to occur from the moment a child is transferred to artificial mixtures or from the moment of complementary feeding, some children form chronic constipation by the time they switch to the common table of the family from 2–3 years old.
In addition to violations of bowel movements , typical manifestations of dolichosigmomas are:
- abdominal pain of a spastic or arching nature,
- flatulence , bloating,
- nausea and vomiting with prolonged constipation
- violation of the absorption of vitamins, signs of self-poisoning metabolic products.
The child is pale, with an increased size of the abdomen on the background of general asthenia and thinness, the tongue is dry and covered with a thick patina, there may be an unpleasant smell from the mouth. Fragility of the nails and hair, bunks in the corners of the mouth, and circles under the eyes are noted.
The course of dolichosigmoid proceeds in three clinical stages:
At the compensated stage, episodic problems with the stool occur in a practically healthy child, but a lengthening of the intestine is detected on the x-ray. There may be bouts of pain in the lower abdomen, but they are rare. Pain relieves or disappears after enemas and stool discharge. The physical development of children does not suffer, the stomach is not painful, the usual form.
In the subcompensated form of dolichosigma, constipation can occur for two or three days, then the chair arises independently. Constipation is stronger and more pronounced during periods of low fiber intake of fruits and vegetables. Problems with the chair and abdominal pain occur almost weekly, there is flatulence, often the chair does not move on its own, which leads parents to enemas. The abdomen may be swollen in the lower half, enlarged.
When decompensation problems occur every day, the stool is delayed for up to five days, it departs only after enemas, abdominal pain and flatulence are strong, the stomach is swollen, greatly increased in size, physical development suffers seriously.
Must be distinguished from the similar flowing dolihosigmoy Hirschsprung’s disease, which is heavier in terms of treatment.
The basis of the diagnosis is complaints of persistent constipation and abdominal pain in children since the introduction of a more dense diet. The basis of the diagnosis of dolichosigma is the probing of the abdomen with the definition of the intestine as a dense, filled with fecal strands, which is expanded and extended.But an accurate diagnosis will be established only by X-ray examination with a contrast agent. The X-ray will clearly show the shape and size of the intestine, its relative location in the abdominal cavity.
An additional study other than the above may be:
- feces for flora (seeding)
- ultrasound scanning of internal organs, especially Ultrasound of the liver.
If necessary, additional studies are carried out gastroscopy, colonoscopy or rectoromanoscopy, with visual inspection of the intestinal wall.
The basis of treatment is the observation of the surgeon and pediatrician, conservative therapy with the use of a balanced diet and laxative products. Also important is the mode of the day and the diet, which must be strictly followed without any relaxation.
Children are prescribed mild laxatives – duphalac or lactulose. Doses of the drug are sampled individually, based on the degree of impairment until regular soft stools appear.
In the hospital when the running cases apply:
- Dibazol and prozerin courses for 15 days,
- B vitamins,
- intestinal electrostimulation method
- To consolidate the result, follow-up care is shown in a specialized sanatorium.
Surgical treatment of dolichosigmomas is prescribed infrequently, in special cases, when persistent, persistent and prolonged constipation occurs, the bowel enlargement progresses and a permanent lesion of its neuromuscular apparatus is detected.
In these cases, resection of excess intestinal loops is performed, and in the rarest cases, the intestine is completely excised.
In most cases, the prognosis of dolichosigmoid for life is quite favorable, with the growth and development of many disorders are compensated, and the chair becomes independent and full.
Surgical treatment today is used in exceptional cases.