Abnormalities of the colon

Abnormalities of the thick (including rectum) gut, according to various authors, occur at a frequency of 1: 1500-1: 5000 newborns. The most common forms of anomalies of the colon are anorectal atresia, atresia of the colon, which clinically manifest immediately after birth and, as a rule, are incompatible with life.

Sometimes anal stenosis and atresia are combined with fistulas that connect the rectum with the bladder, urethra, and in girls - also with the vagina. Sometimes the fistulous canal goes into the perineum. In some cases, anal stenosis can be expanded, and these children survive. In some cases, and fistulas, combined with anal atresia, newborns with this pathology can provide surgical assistance.

[1], [2], [3], [4], [5], [6], [7], [8]

Congenital megacolon

[9], [10], [11], [12], [13], [14], [15]

What causes a congenital megacolon?

Congenital megacolon is a hereditary disease, the type of inheritance, apparently, is autosomal recessive. Identical twins usually both suffer from this disease. A frequent combination of Hirschsprung's disease with other malformations is noted: with Down's disease, enlarged bladder (megacystis), diverticula of the bladder, hydrocephalus, etc. There is an inborn megacolon with a frequency of 1: 5000 newborns.

Congenital megacolon - a significant expansion of part or the entire colon, usually with a thickening of the muscular wall of its wall. Congenital megacolon can be caused by any obstacles for further movement of the contents of the colon (stenosis, membranous lintels, etc.), but more often is a congenital anomaly of its innervation - congenital agacglosis. This form is usually called Hirschsprung's disease - congenital absence of nervous ganglia or insufficient number of them for normal functioning of the large intestine. In the areas of the colon lacking normal innervation, there is no peristalsis or the amplitude and strength of peristaltic waves are significantly reduced, the propulsive capacity of the gut suffers. More often these changes are localized in the sigmoid colon (megadolioschigma), but the entire large intestine (megadolicholone) can be affected.

In the pathogenesis of the congenital megacolon, the main significance is the aganglion of the site of the large intestine. As a result, there are dystrophic changes in the muscular layers of the intestine, where there are the greatest changes in the musculoskeletal and submucosal nerve plexuses. Initially there is compensatory hypertrophy of the muscular tissue of the more proximal part of the intestine (with regional megacolondolyshogsigma), later - dystrophic changes in muscle fibers in these areas (due to a constant workload), and replacement of their connective tissue, which leads to an even greater expansion of the gut proximal to the aperistaltic zone.

Symptoms of congenital megacolon

In most cases, Hirschsprung's disease is detected already in the first days after birth - lack of allocation of meconium, bloating, sometimes vomiting. Approximately 20% of newborns have persistent diarrhea due to the development of pseudomembranous colitis. Mortality, despite all the measures taken, is very high and reaches 70-75%. Children whose submucosal and musculoskeletal plexus are less severely affected and who manage to survive this initial, very difficult period, later suffer constipation, which requires almost daily enema and laxatives. Possible bloating, flatulence. In children suffering from this disease, growth slows down, they look younger than their age. Often they have anemia, hypoproteinemia, hypovitaminosis.

Diagnosis is confirmed by the data of X-ray examination (irrigoscopy), in specialized gastroenterological institutions, peristalsis and pressure in the colon are recorded, which also facilitates diagnosis. Especially indicative is a trial with mecholil (a drug of the group of cholinomimetics), after injection of which the tone and phase activity of the normally innervated parts of the colon decrease, but the tonus of its denervated areas increases.

Complications of congenital megacolon

In older children and adolescents, due to the prolonged delay of fecal masses, proximal to the aganglionic zone of gradual and more significant than normal absorption of water and compaction of the intestinal contents, including iliac, the occurrence of intestinal obstruction is possible. In some rare cases, due to the prolonged pressure of fecal masses, so-called fecal ulcers appear on the intestinal wall, and sometimes - perforation of the intestinal wall followed by the development of peritonitis.

Differential diagnosis of Hirschsprung's disease in adults is carried out with organic violations of the patency of the colon - stenoses, compression, including spikes after operations performed in the past on another occasion, narrowing or obturation of the lumen of the intestine with a tumor, large polyp, etc. In some regions South America is fairly widespread disease caused by trypanosome Krutz (Chagas disease), which affects the nerve plexus of the digestive tract. Later, in persons who have recovered from the acute form of this disease, a megacolon, a mega-esophage, a widening of the stomach, atony and dilatation of the bile and bladder develop; with changes most often localized in the esophagus (creating difficulties for differential diagnosis with cardiac achalasia ) or in the large intestine (differential diagnosis with a congenital megacolon).

[16], [17], [18],

Additional loops of the sigmoid colon

There are also additional loops of the sigmoid colon with some expansion and almost constant constipation. In some cases, for many years, a prolonged stool delay for several days is purely neurogenic "psychogenic", it also occurs in parkinsonism, long-term use of a number of medications that impair tone and peristalsis of the digestive tract, etc. Naturally, due to the accumulation fecal masses of the large intestine, especially in the distal sections, will expand. With systemic scleroderma and some other diseases, atrophy of the muscular layers of the intestinal wall occurs, the tone of the colon decreases, it expands. However, with systemic scleroderma there are a number of external signs characteristic of this disease (acrocyanosis, Raynaud's syndrome, trophic ulcers at the tips of fingers and toes, a symptom of "pussy" - tightening the skin in the folds around the mouth, etc.), which in most cases to establish the diagnosis.

With relatively small areas of aganglionis of the colon, surgical treatment is possible, and several modifications of operations are suggested. In other, usually more mild cases, throughout life, siphon enemas with a large volume of liquid, up to 2 liters, are taken internally with vaseline oil to improve the passage of the contents of the large intestine, and to engage in specially selected therapeutic gymnastics for this disease.

[19]

Congenital diverticulum of the colon

Among other abnormalities of the large intestine are her inborn diverticula, doubling of the large and small intestine, communicating or not communicating with the lumen of the intestine; the latter resemble a cyst-like cavity. The diagnosis is difficult. They proceed for a long time asymptomatic, or are manifested by pain caused by overgrowing of the cyst contents or intestinal obstruction. Contrast X-ray examination sometimes reveals doubling of the intestine, communicating with its main tract. Perhaps ultrasound and computed tomography facilitate the diagnosis of this rare anomaly. In most cases, the diagnosis is possible during laparotomy. Treatment is surgical.

[20], [21], [22], [23], [24], [25], [26]