Megacolon

The gigantism of the entire colon, or its site, acquired or inherent, is indicated by the term megacolon.

This disease is unpleasant not only in physical terms, but also causes a certain psychological trauma to the patient.

[1], [2], [3], [4], [5], [6],

Causes of the megacolon

That the doctor - the gastroenterologist or the proctologist could spend qualitative treatment, he should reveal the primary source of a problem, after all only having eliminated it, it is possible to speak about efficiency of therapy. But in order for the source to be found, it is necessary to know the causes of the megacolon, which are capable of provoking this pathology:

• The disease can be congenital (Hirschsprung disease), received in the womb of the mother.
  • This disease occurs when peripheral receptors are completely or partially absent.
  • This may be a failure that occurred in the process of embryogenesis, when the ability of neurons to move through the nerve processes is impaired. This deviation from the norm leads to changes in the conductivity along the nerve pathways.
• The disease can have acquired character:
  • Injury.
  • Defeat of toxic nature. Here you can also include medicinal constipation.
  • Tumor lesions of the nerve plexuses in the wall of the large intestine.
  • Hypothyroidism is an endocrinological pathological abnormality arising from a disturbance in the balance of thyroid hormones in the body.
  • Dysfunction of the central nervous system in the case of diagnosing Parkinson's disease.
  • Lesion of the intestinal mucosa with fistulas.
  • Mechanical narrowing of the large intestine, which occurred because of colloid scars, obtained by the patient after an operative intervention affecting the intestine.
  • Collagenosis - a group of diseases in which there is a systemic lesion of connective tissue and blood vessels. For example, scleroderma, characterized by local, visually conspicuous tissue tightening.
  • Amyloidosis of the intestine is a serious violation of protein-carbohydrate metabolism.

[7], [8], [9]

Symptoms of the megacolon

The severity of the clinical picture directly depends on the area of the affected area and the ability of the organism of the victim to compensate. Symptoms of the megacolon are quite unpleasant and in the case of congenital genesis they begin to manifest themselves immediately after birth, with the acquired megacolon this symptomatology begins to increase as the pathology develops.

Symptoms of this disease include:

• In newborns there is no independent release of the intestine. Adults have chronic constipation.
• Pathology is accompanied by severe pain symptoms.
• There is a feeling that a person is bursting from the inside. A small patient even visually can observe an increase in the circumference of the abdomen.
• There are signs of flatulence.
• With noticeable periodicity, vomiting occurs. Vomit, often come with mixing of bile.
• With a severe form of pathology, the patient can get rid of stool only after he was delivered a gas outlet tip, or a siphon or purifying enema procedure was performed.
• Gradually, if you do not take measures, there are signs of chronic intoxication: pallor of the skin, an increase in temperature indicators of nausea and others.
• When the faecal masses come out, stool feces, mainly, have undigested pieces of food, blood and mucus. The smell of feces is very fetid.
• In small patients who have a megacolon, a general depletion of the body is often documented. Against this background, anemia begins to develop, and the baby lags noticeably in development.
• Constant constipation causes thinning of the thickness of the walls of the large intestine. The mucous membrane becomes flabby, and its large volumes lead to the so-called "frog stomach". In this condition, through the anterior wall of the peritoneum, the peristalsis of fecal masses is perfectly visible, especially in the enlarged loops of the large intestine.
• The pulmonary diaphragm is higher than it is supposed to be at the norm.
• The volume of air transported by the lungs decreases.
• Due to the fact that the intestine occupies a sufficient amount of space in the patient's body, other internal organs are displaced.
• There is a deformation of the forms and parameters of internal organs, the thorax takes a barrel-like appearance.
• It begins to appear clearly cyanosis.
• Quite often there are symptoms of dysbiosis, which provokes the progression of secondary inflammation.
• The patient appears shortness of breath.
• There is an increase in the heart rate.
• When conducting regular electrocardiograms, progressive changes in the work of the heart are seen.
• Due to changes in the respiratory system, the patient often suffers from catarrhal diseases, pneumonia and bronchitis.
• Gradually, acute intestinal insufficiency may develop.
• With a severe degree of pathology, perforation of the intestinal mucosa may occur, which causes paradoxical diarrhea.
• Physically obstructing obstruction of the intestine develops.
• In case of neglect of the disease can be observed perforation of the gut.
• With severe pathology, develops peritonitis.
• In the event that the intestine has undergone a twist, or a narrowing of the passage is formed in it, strangulation intestinal obstruction appears.
• During attacks, the patient has mental problems.
• In particularly severe cases, the patient may fall into a state of shock.

Toxic megacolon

Megacolon is a serious enough and dangerous disease, characterized by an increase in the diameter of the intestine: its swelling, the settling of large amounts of fecal matter in it, an inflammatory process affecting the walls of the intestine. The causes of pathological changes are very different. A toxic megacolon is diagnosed if the cause of the disease lies in the viral, bacterial, mucosal lesions of the colon, the discordance of the intramural ganglia or the reaction of the patient's body to the administration of certain medicinal drugs. To this result, for example, may result in increased dosages or prolonged intake of laxatives.

This type of pathological changes is rare, diagnosis of a toxic megacolon accounts for 1-2% of the total number of cases of a given disease. Pathology progresses quite actively and refers to diseases that pose a particular danger to the life of the patient. Therapy is possible only in a hospital.

For the most part, the main cause of the toxic megacolon is Crohn's disease (chronic inflammatory mucosa and intestinal walls, which is expressed by violation of the integrity of the mucosa of the small and large intestine) or ulcerative colitis (pathology of the chronic nature of the inflammatory nature with ulcerative and destructive changes in the walls of the rectum and colon). In patients with this pathology, a toxic megacolon can develop as a concomitant disease or be caused by the taking of a number of drugs while undergoing therapeutic treatment of the underlying pathology.

Idiopathic megacolon

This type of pathology occurs quite often and ranks second in the number of diagnoses. An idiopathic megacolon shows a clinical picture similar to that of Hirschsprung's disease, the only difference is that the symptomatology is less intense and the sufferings of the patient are not so painful. When palpation is palpated an enlarged volume of the rectum, filled with a large number of bowel movements. Differences are clearly visible only on the X-ray. With this pathology, the increase in the diameter of the intestine occurs immediately immediately from the anus and no narrowing occurs along the bowel. The force of locking the sphincter of the anus is also reduced. These biopsies with this type of pathology are often contradictory. Some of the results of the examination indicate dystrophic changes in the structure of intramural ganglia, while the other half indicates their normal state.

The term idiopathic megacolon is cited by those cases of gigantism of the rectum and colon, in which there is no structural anatomical obstruction, both acquired and congenital genesis. With this form of the disease, the aganglionic zone remains normal.

For young patients, an immaterial precedent in the development of an idiopathic megacolon is the immaturity of the formation of an innervation apparatus that connects organs and tissues to the central nervous system with the help of nerves. He is exposed to the influence of unfavorable factors, which trigger the mechanism of pathological changes. Many medical workers consider the main reason for the development of pathology of this type of functional changes that affect the autonomic nervous system.

Increased irritation of the parasympathetic nerves leads to an increase in the intestinal tone, while the muscles of the anal opening relax. When the sympathetic nerves are irritated, the reverse process occurs, when the muscles of the intestine relax, and the sphincter contracts. Therefore, a violation of this process leads to a pathological expansion of the intestinal volumes.

Functional megacolon

This form of pathological increase in the diameter of the rectum and colon is formed if a mechanical obstacle is encountered in the path of stool. Mostly, a functional megacolon can be caused by congenital stenosis (significant reduction or complete closure of the lumen of the gut), as well as atresia (congenital or acquired fusion of the walls) of the anus. Call the pathology of the form in question can hemangioma (a benign neoplasm that is formed due to the accumulation of blood vessels) of the rectum or neoplasm of the villous character of the rectosigmoid sector.

Provoke the development of a functional megacolon and adhesive adhesions, obtained as a consequence of surgical treatment of the abdominal cavity, as well as postoperative deformity of the sphincter and / or rectum.

When the stool mass moves through the intestine at the moment of their collision with a mechanical obstruction, the peristalsis primarily amplifies and hypertrophic changes in the intestinal wall of the overlying segments occur, then the moment begins when decompensation begins, at which the intensity of excitation of the nerve centers decreases, against which there is an increase in the diameter of the intestine , stretching its walls. A persistent dystrophic condition begins to form, which subsequently develops into irreversible sclerotic disorders of the muscular and mucous layer.

Medical statistics show that a functional megacolon is diagnosed in 8-10% of cases of recognized gigantism of the large intestine.

There are cases when the diameter of the intestine of an adult patient reached 30 cm.

Megacolon in adults

In adults, both congenital and functional manifestations of gigantism of the large intestine are diagnosed. With the birth of a patient, a slowly developing Hirschsprung disease can acquire. Functional manifestations of gigantism are based on inertia of the muscular tissue of the large intestine. The second major factor capable of provoking such changes in the gut may be a motor impairment caused by organic changes occurring in the central nervous or endocrine system.

Such patients have a pronounced tendency to constipation, which can develop from early childhood and reach its apogee by 20-30 years (with congenital genesis). With the acquired pathology, problems with bowel movement occur later. The symptomatology is identical to the one described above.

Megacolon in adults is not well understood. But those cases of the manifestation of the disease, which are known to medicine, experts carry on several types. The type of pathology directly depends on its pathogynece and etiology:

1. Hirschsprung's disease or aganglionic megacolon is a congenital disease caused by underdevelopment of individual segments or the entire intramural nervous apparatus of the intestine.
2. Psychogenic megacolon. Progression of this pathology can trigger a mental disorder or poor reflex habits present in the patient. For example, if he for a long time, for whatever reason, suppresses the desire for defecation. That is, the problem itself consists in the untimely devastation of the large intestine from feces. This pathology is diagnosed in 3-5% of the total number of certain cases.
3. Gigantism of obstructive nature. The reason for its appearance is a mechanical obstruction, which is met on its way during evacuation from the body of stool masses.
4. Endocrine megacolon is diagnosed if the disease is caused by endocrine system diseases. Predominantly, such pathological changes as cretinism (caused by a deficiency of thyroid hormones) or myxedema (a severe form of hypothyroidism) can lead to gigantism. The pathology of this type is diagnosed in 1% of the total number of certain cases.
5. A neurogenic megacolon basically has organic lesions of the central nervous system. Mostly, such a clinical picture gives such a disease as meningoencephalitis. Due to pathological changes affecting the nerve endings, there is a general disruption of the centers responsible for motor-evacuation work of the intestine, which leads to persistent and prolonged constipation. This pathology is found in 1% of patients with CNS damage.
6. A toxic megacolon can develop on the background of taking some medications or as a result of an infectious "aggression" that affects the intramural ganglia of the large intestine. The pathology of this type is revealed in 1 - 2% of patients who are diagnosed with gigantism of the rectum.

Megacolon in children

Congenital megacolon in children is diagnosed in one case for 10-15 thousand children born. Mostly this pathology is sick boys. From the very birth of such babies may suffer from constipation or complete obstruction of the intestine. But in most cases it starts to get the baby from the second or third month of his life. From the very beginning, one can observe a progressive increase in the volume of the abdominal circumference. Basically, the intestine increases its size downwards, and is seen slightly shifted to the left.

Megacolon in children is manifested by persistent compaction of feces - independent emptying of the intestine may not be observed for two to three weeks. Not allowing this, the intestines are cleaned due to the siphon enema delivered to the patient. The kid almost constantly suffers from flatulence. The gas does not completely leave, accumulating in the intestine. And to get rid of them the baby's tummy works, often, only with the help of a gas pipe. There are cases when prolonged constipation was sharply replaced by atypical diarrhea.

The accumulation of large amounts of bowel movement in the intestines causes vomiting in the immature organism, which leads to dehydration and intoxication of the body.

When palpating the baby's belly, the expert feels either a very tight stool or a softer consistency with the impregnation of fecal stones. When pressing on the tummy of the baby in the place of localization of the stool, for a certain time you can observe a "dent" (the effect is akin to pressing on a piece of clay). After the defecation process, which was preceded by a stagnant period, stool feces are very fetid.

Ignore this pathology is impossible, as its further progression leads to even more severe pathologies. For example, as complete intestinal obstruction, perforation of its walls, perforation of the sigmoid and / or large intestine. And as the final result - developed peritonitis and death.

Functional megacolon in children

Frequent constipation in a child can be associated with the presence of abnormalities in the body of the baby that are functional and affect the functionality of the large intestine. Modern statistics has very little knowledge about the frequency of the affected children's disease. This fact is related to the low sanitary education of the population, when young mothers simply do not know how many times a day her baby has to "walk around a lot". In addition, there are currently no single accepted criteria based on which pediatricians can judge the presence or absence of pathological changes in the child's body.

Some researchers believe that every second to fourth child suffers from constipation to some extent, while pre-school children suffer from this pathology three times more often than schoolchildren.

It is worth noting that the functional megacolon in children can be false. This can happen when the baby receives little mother's milk. The cause may be: hypogalactia in the mother, voluminous regurgitation in the child, the presence of wounds in the mouth of the baby.

Predisposition to a functional megacolon in children is directly related to a genetic predisposition, burdened family history.

Most often, the source of gigantism is one or more functional deviations, leading to a malfunction in the motor-evacuation work of the large intestine. Mainly the impetus to pathological disorders is the mismatch in the coordination of propulsive and tonic contractions of the muscles of the walls of the organ under consideration.

Normal emptying of the intestines in children depends to a large extent on traumatology or posthypoxic intestinal lesions. Virtually all those changes that affect an adult can cause a functional megacolon in children.

Quite often, the type of constipation in question occurs in the child due to the depression of the urge to defecate. This may be due to the fear of the baby pot or an older child, fearing the ridicule of peers, is afraid to go to the toilet while in the kindergarten or school.

Chronic constipation can wear and form neuroses. Especially such development of pathology is inherent in small children up to two years, if he does not have normal contact with the mother (he is afraid of her or, conversely, her mother for some reason, for a certain time, had to part with him).

For children of school age, the most common cause of problems with defecation is the lack of a child's habit of regular defecation, as well as suppressing the urge to empty the bowels during the lesson, the game, as well as in case of a cracks in the intestinal mucosa or the child has fear before this process.

A functional megacolon in children can also cause some pharmacological drugs. This organism is able to show such a response to miore¬lak¬santy (drugs that relax the human striated muscles), anticonvulsant drugs, holinolitiki (substances that block the natural mediator acetylcholine). To the gigantism of the large intestine in the child can lead and long-term use of diuretics and laxatives, washing out from the kid's body potassium and reducing the contractile activity of smooth muscles.

Therapeutic treatment, which includes tranquilizers and antidepressants, has a depressing effect on the subcortical and cortical areas of the brain, including those responsible for defecation.

There are cases when constipation is observed after the baby has been ill with dysentery or another infectious disease, the manifestation of which is profuse diarrhea. Such metamorphosis is due to the violation of intramural ganglia, which develops on the basis of intestinal dysbiosis, caused by a decrease in the number of "useful" flora.

In our computer age, if little children move in some way, then teenagers, largely affected by the "virus" of computerization, are burdened with hypodynamia - this approach to the child regimen can lead to weakening of intestinal motility, and, consequently, to constipation.

Diagnostic megacolon

In order for therapeutic therapy to have a positive result, a qualitative diagnosis of the megacolon, which is carried out by a qualified specialist, is necessary.

• The primary gastroenterologist or proctologist performs an analysis of the patient's complaints and a visual examination. In this case, he draws attention to the increased size of the abdomen, its asymmetry.
• The doctor palpates the loops of the bowel, filled with feces. This simple procedure makes it possible for the doctor to feel the density of the stool or the differentiated "stool stones" in it.
• When you click on the stomach, you get the effect of clay. After pressing in the area of the swollen intestinal loop, there is a dent for a while at the pressure site.
• Collection of anamnesis of the patient: hereditary predisposition, whether the patient was sick with infectious diseases and so on.
• General radiography of the abdominal cavity is performed. This analysis makes it possible to identify enlarged intestinal loops of the large intestine, a highly located dome of the pulmonary diaphragm.
• Endoscopic diagnostics.
• Laboratory studies of feces on bacterial flora.
• Obtaining a coprogram. Bakposev to identify the main infection.
• A blood test for anemia and a high content of white blood cells.
• If necessary, colonoscopy or sigmoidoscopy is performed - these two survey methods rather complement each other, allowing visualization of the colon examination. This technique, with the connection of endoscopy, allows you to take material for further biopsy.
• Histological examination.
• Radiocontrast irrigoscopy allows the specialist to see narrowed segments of the intestine, over which the swelling of the intestine is seen. The study allows us to consider the circular protrusions of the colon wall, the smoothness of their contours. The result of the analysis can be a diagnosis: megorektum - excessive increase in the rectal area, megasigma - pathological expansion in the sigmoid colon and megacolon - whole colon pathology.
• If the analysis revealed the absence of nerve cells in the Auerbach's plexus in biomaterial taken from a biopsy from the intestinal mucosa wall, then Hirschsprung's disease is diagnosed.
• The proctologist often appoints anorectal manometry, the results of which allow you to assess the state of the rectal reflex, as well as determine which genesis the megacolon belongs to: congenital pathology or acquired one. If structural and physico-chemical analyzes of ganglia did not show abnormalities in its parameters, with reflexes preserved, therefore, the disease belongs to acquired pathologies and Hirschsprung's disease is absent.

Megacolon slowly enough progresses in the body of an adult patient, with the symptomatology may be slightly blurred and mildly expressed. Therefore, it is possible to recognize it at an early stage of development only with the help of X-ray study.

[10], [11], [12], [13], [14], [15], [16], [17]

Treatment of megacolon

Only after conducting a multifaceted examination and setting the right diagnosis can we talk about complex therapy. Treatment of megacolon mainly begins with surgical intervention. If congenital pathology is diagnosed, then it is advisable to carry out the operation at the age of two to three years. Until the time of surgery (for both children and adult patients), the patient's condition is supported by conservative therapy.

Its principle is to maintain the patient's regular defecation. To ensure this process, the patient signs a laxative diet, which necessarily introduces food that can enhance peristalsis. This is a group of sour-milk products, dishes from beetroot, carrots, apples, bran, prunes and many others.

Quite effective show abdominal massages. With the palm of the hand (for children) or with a clenched fist (or wound on an upper limb by an adult towel), press circular movements. The movement starts from the top point of the abdomen and is clockwise (during the natural movement of the fecal masses). Massage should be done 10 to 15 minutes before each meal.

Effective and therapeutic exercise, which is directly aimed at increasing the tone of the abdominal muscles, is also quite effective.

The doctor can advise to soften the stool, adults should drink two to three tablespoons of vegetable oil three times throughout the day, and the children one tablespoon once a day.

Treatment of megacolon does not allow the administration of drugs that have a laxative effect. Some patients, engaged in self-medication, prescribe such medicines. With prolonged admission, such patients have to constantly increase the dosage of the medication administered, which only aggravates the health situation, and can also provoke intestinal obstruction.

Before surgical treatment, a patient with a megacolon diagnosis has to be content with regular enemas. They can be of various types: hypertensive, siphon, vaseline and purifying. The appointment is made by the attending physician, based on the clinical picture of the disease and the patient's state of health during the period of therapy. For example, it is very important for cleaning and siphoning procedures to ensure that the water introduced is at room temperature. If it has a higher temperature, it is better absorbed by the mucosa, which can only exacerbate the situation (especially with a toxic megacolon).

Immediately after carrying out the cleaning procedure, a tube is put in order to remove the gases and the remaining liquid.

If the patient is hospitalized in a critical condition, the first thing he is trying to do is to reduce the intestinal volume to prevent his perforation and the development of peritonitis. For this purpose, a tube is inserted through the nasal or oral cavity of the patient to the intestines to remove the liquid and gas accumulated there. If necessary, blood transfusion is performed. The patient receives the food through the droppers intravenously.

Antibiotics can be used in therapy. Their task is to quash the existing concomitant pathogenic flora or blood infection, obtained due to developing sepsis.

To maintain the balance of the flora in the intestine, bacterial preparations are prescribed: bifikol colibacterin, bifidumbacterin.

Bifikola colibacterin is prescribed for ingestion within half an hour before meals. Depending on the age of the patient and the severity of the pathology, the doctor assigns one to five doses taken twice a day. The duration of treatment is two to three weeks. If necessary, the course of therapy is repeated, but not earlier than two months later.

Contraindication to taking the medicine is the individual intolerance of the constituents of the drug, as well as the presence in the history of a specific and nonspecific ulcerative colitis.

Assign enzyme drugs that improve the digestive system. For example, pancitrat, pancreatin, mezim, panragol, panzinorm forte-H, penzital, festal-P and others.

Mezim is assigned to adult patients by one - two dragees, which are taken immediately before meals. Contraindication to taking the drug is inflammation of the liver tissue, increased intolerance of the constituents of the drug, mechanical jaundice.

Prokinetics of modulators of the motility of the large intestine: motilac, damelium, motoneum, domstal, motinorm, domet, passenger, domperidone, motilium, domperidone, hexal.

Motion is injected inside half an hour before meals. The recommended average dosage for children over the age of five is 10 mg taken three to four times throughout the day. If necessary, you can enter another reception just before bedtime. If there are medical indications, the amount of a single-dose drug can be doubled, the number of receptions remains the same.

For patients suffering from renal dysfunction, the dose must be corrected, and the number of inputs must not exceed one to two times.

It is not recommended to take this drug with gastric bleeding, hypersensitivity of the patient's body to the components of the medicine, intestinal obstruction, perforation of the mucosa of the digestive tract, as well as to children under five years old or weighing less than 20 kg.

Often, a doctor is appointed and electrostimulation of the rectum - the effect of small currents on the affected organ. Such irritation causes the intestines to become more active and improve their functioning.

Operative treatment megacolon

Surgical intervention is prescribed in cases where conservative treatment is not able to lead to an effective resolution of the problem. Operative treatment of megacolon presupposes excision of the affected area of the intestine, and the remaining "healthy" parts are joined together.

There are cases when in one operation you can not do this, then the upper segment of the large intestine has to be withdrawn through the abdominal cavity. Colostomy can be both permanent (and the patient has to live with it for the rest of his life, using special devices for calving), and temporary (when a repeated operation for reconstructing the large intestine is being performed).

In mechanical forms of the megacolon, the task of the operation is to eliminate narrowed spaces throughout the intestine, which are an obstacle to the normal passage of feces. In this way, spikes, cicatricial stenosis, as well as fistulous atresia and other pathologies are removed.

After the surgical intervention the patient undergoes postoperative recovery with the use of drug therapy, which includes antibiotics, anti-inflammatory drugs and vitamin-mineral complex, there is a correction of nutrition. Rehabilitation is caused by special exercises and physical exercises, which are designed to improve the state of muscle tone of the intestine and strengthen the muscles of the abdominal press.

Subsequently, after surgical treatment, the patient is still on one-and-a-half years of age on dispensary registration under the supervision of a qualified specialist.

Prevention of the megacolon

Any warning of a disease is protecting your body from pathology or at least alleviating its symptoms. Prevention megacolon is, first of all, in a correct and balanced diet. In the diet of any person should be enough food that dilute feces (but should not get carried away by them, everything should be in moderation), as well as foods with a high fiber content, stimulating the nerve endings of the intestinal walls, forcing them to work more actively. We welcome dishes from stews and raw fruits and vegetables, sour-milk products. Then it's worth to reduce the volumes of consumed jelly, sweets, fresh baked goods, viscous cereals.

It is necessary to lead an active life, hypodynamia is an ally of the megacolon. It is necessary to get rid of bad habits: alcohol, drugs and nicotine will not add health. Massages and exercise therapy will strengthen the muscles of the abdominal press and the musculature of the walls of the intestine and sphincter.

The megacolon forecast

The answer to this question is ambiguous and depends on the patient's condition, as well as the severity of the disease that affected him. If the pathology has captured a significant part of the intestine, and is accompanied by persistent constipation, the patient has all the signs of intoxication, then the megacolon's prognosis is rather deplorable. With poor care of the main anamnesis, intestinal obstruction is added, infectious damage and exhaustion of the body is a 100% lethal outcome.

Less often there are cases of death from peritonitis, which develops on the background of perforation of intestinal walls.

But if the disease was diagnosed still in an unopened form, and adequate treatment was carried out, then the megacolon's forecast is fairly optimistic. After treatment, a person continues to live a full life.

Look what the modern person eats. Accustomed to other foods for centuries, our digestive tract can not cope with the amount of "chemistry" that gets into it, reacting with various pathological changes. One of the most frequent deviations from the norm are constipation, which, if not respond, can subsequently lead to the development of a pathology such as a megacolon. In this situation, you can give only one piece of advice: "Dear respondents, take a closer look at your diet! Only you can save your health and life! "If there are signs of constipation, and it appears with regular persistence, then do not hesitate to visit a specialist.