Megacolon

Gigantism of the entire colon, or its part, acquired or congenital, is designated by the term megacolon.

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

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

Causes of Megacolon

In order for a doctor - gastroenterologist or proctologist to conduct high-quality treatment, he must identify the primary source of the problem, because only by eliminating it can we talk about the effectiveness of the therapy. But in order for the source to be found, it is necessary to know the causes of megacolon, which can provoke this pathology:

• The disease can be congenital (Hirschsprung's disease), acquired in the womb.
  • This disease occurs when peripheral receptors are completely or partially absent.
  • This may be a failure that occurred during embryogenesis, when the ability of neurons to move along nerve processes is impaired. This deviation from the norm leads to changes in conductivity along nerve pathways.
• The disease can also be acquired:
  • Injury.
  • Toxic lesions. This also includes drug-induced constipation.
  • Tumor lesions of the nerve plexuses in the wall of the colon.
  • Hypothyroidism is an endocrinological pathological deviation that occurs due to an imbalance of thyroid hormones in the body.
  • Dysfunction of the central nervous system in case of diagnosis of Parkinson's disease.
  • Damage to the intestinal mucosa by fistulas.
  • Mechanical narrowing of the colon caused by colloid scars obtained by the patient after surgery involving the intestine.
  • Collagenoses are a group of diseases in which systemic damage to connective tissue and blood vessels is observed. For example, scleroderma, characterized by local, visually noticeable tissue compaction.
  • Intestinal amyloidosis is a severe disorder of protein-carbohydrate metabolism.

[ 7 ], [ 8 ], [ 9 ]

Symptoms of Megacolon

The severity of the clinical picture directly depends on the area of the affected area and the ability of the victim's body to compensate. The symptoms of megacolon are quite unpleasant and in the case of congenital genesis they begin to manifest themselves immediately after birth, with acquired megacolon these symptoms begin to intensify as the pathology develops.

Symptoms of this disease include:

• Newborns do not have spontaneous bowel movements. Adult patients experience chronic constipation.
• The pathology is accompanied by severe pain symptoms.
• There is a feeling that the person is being pushed apart from the inside. In a small patient, you can even visually observe an increase in the circumference of the abdomen.
• Signs of flatulence are observed.
• Vomiting occurs with noticeable frequency. Vomiting often contains bile.
• In severe forms of the pathology, the patient can get rid of feces only after he has been given a gas-discharge tip, or a siphon or cleansing enema procedure has been performed.
• Gradually, if no measures are taken, signs of chronic fecal intoxication appear: pale skin, increased temperature, nausea, and others.
• When fecal matter is released, fecal excrement mainly contains undigested pieces of food, blood and mucus. The smell of feces is very foul.
• Young patients diagnosed with megacolon often experience general exhaustion of the body. Against this background, anemia begins to develop, and the baby noticeably lags behind in development.
• Constant constipation causes the walls of the large intestine to become thinner. The mucous membrane becomes flabby, and its large volumes lead to the so-called "frog belly". In this condition, the peristalsis of feces is clearly visible through the anterior wall of the peritoneum, especially in the enlarged loops of the large intestine.
• The pulmonary diaphragm is located higher than it should be under normal conditions.
• The volume of air transported by the lungs decreases.
• Due to the fact that the intestines take up a sufficient amount of space in the patient’s body, other internal organs are displaced.
• The shapes and parameters of the internal organs are deformed, and the chest takes on a barrel-shaped appearance.
• Cyanosis begins to become clearly visible.
• Quite often, symptoms of dysbacteriosis appear, which provokes the progression of secondary inflammation.
• The patient experiences shortness of breath.
• An increase in heart rate is observed.
• When performing regular electrocardiograms, progressive changes in the functioning of the heart are visible.
• Due to changes in the respiratory system, the patient often suffers from colds, pneumonia and bronchitis.
• Acute intestinal failure may gradually develop.
• In severe cases of pathology, perforation of the intestinal mucosa may occur, which causes paradoxical diarrhea.
• Physically obstructing intestinal obstruction develops.
• If the disease is advanced, intestinal perforation may occur.
• In severe pathology, fecal peritonitis develops.
• If the intestine has undergone a volvulus or a narrowing of the passage section has formed, strangulation intestinal obstruction occurs.
• During attacks, the patient develops mental problems.
• In particularly severe cases, the patient may go into shock.

Toxic megacolon

Megacolon is a rather serious and dangerous disease characterized by an increase in the diameter of the intestine: its bloating, sedimentation of large volumes of feces in it, an inflammatory process affecting the intestinal walls. The causes of pathological changes are very different. Toxic megacolon is diagnosed if the cause of the disease lies in a viral, bacterial lesion of the colon mucosa, a mismatch of intramural ganglia or the patient's body's reaction to the introduction of certain medicinal drugs. For example, increased dosages or prolonged use of laxatives can lead to such a result.

This type of pathological changes is rare, the diagnosis of toxic megacolon accounts for 1-2% of the total number of cases of this disease recorded. The pathology progresses quite actively and is related to diseases that pose a particular danger to the patient's life. Therapy is possible only in a hospital setting.

In most cases, the main cause of toxic megacolon is Crohn's disease (chronic inflammation of the mucous membrane and intestinal walls, expressed by a violation of the integrity of the mucous membrane of the small and large intestine) or ulcerative colitis (a chronic pathology of an inflammatory nature with ulcerative-destructive changes in the walls of the rectum and colon). In patients with such pathology, toxic megacolon can develop as a concomitant disease or be caused by taking a number of drugs during therapeutic treatment of the underlying pathology.

Idiopathic megacolon

This type of pathology is quite common and ranks second in terms of the number of diagnoses. Idiopathic megacolon shows a clinical picture similar to the symptoms of Hirschsprung's disease, the only difference is that the symptoms are less intense and the patient's suffering is not so excruciating. When palpating, an enlarged volume of the rectum filled with a large amount of feces is felt. The differences are clearly visible only on an X-ray. With this pathology, the increase in the diameter of the intestine occurs directly from the anus and there are no narrowing sectors along the intestine. The locking force of the anal sphincter also decreases. Biopsy data for this type of pathology are often contradictory. Some of the examination results state dystrophic changes in the structure of the intramural ganglia, while the other half indicates their normal condition.

The term idiopathic megacolon refers to those cases of gigantism of the rectum and colon in which there is no structural anatomical barrier, either acquired or congenital. In this form of the disease, the aganglionic zone remains normal.

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

Increased irritation of the parasympathetic nerves leads to increased intestinal tone, while the anal muscles relax. When the sympathetic nerves are irritated, the reverse process occurs, when the intestinal muscles relax and the sphincter contracts. Therefore, the disruption of this process leads to pathological expansion of the intestinal volume.

Functional megacolon

This form of pathological enlargement of the rectum and colon diameter is formed if there is a mechanical obstruction on the path of fecal matter. Functional megacolon can be mainly caused by congenital stenosis (significant reduction or complete closure of the intestinal lumen), as well as atresia (congenital or acquired fusion of the walls) of the anal opening. The pathology of the considered form can be caused by a hemangioma (a benign neoplasm that is formed due to the accumulation of blood vessels) of the rectum or villous neoplasms of the rectosigmoid sector.

Adhesive scars resulting from surgical treatment of abdominal organs, as well as postoperative deformation of the sphincter and/or rectum, can also provoke the development of functional megacolon.

When fecal matter moves through the intestines, at the moment of its collision with a mechanical obstacle, peristalsis initially intensifies and hypertrophic changes in the intestinal walls of the overlying segments occur, then a moment comes when decompensation begins, during which the intensity of excitation of the nerve centers decreases, against the background of which the intestinal diameter increases, its walls stretch. A persistent dystrophic condition begins to form, which subsequently develops into irreversible sclerotic disorders of the muscular and mucous layer.

Medical statistics show that functional megacolon is diagnosed in 8-10% of cases of recognized colon gigantism.

There have been cases where the intestinal diameter of an adult patient reached 30 cm.

Megacolon in adults

In adults, both congenital and functional manifestations of colon gigantism are diagnosed. At birth, the patient may acquire slowly developing Hirschsprung's disease. Functional manifestations of gigantism are based on the inertia of the muscular tissue of the colon. The second main factor capable of provoking such changes in the intestine may be a violation of motility caused by organic changes occurring in the central nervous or endocrine system.

Such patients clearly have a tendency to constipation, which can develop from early childhood and reach its peak by the age of 20–30 (in case of congenital genesis). In case of acquired pathology, problems with bowel movements appear later. The symptoms are identical to those described above.

Megacolon in adults has not been sufficiently studied. But those cases of the disease that are known to medicine, specialists divide into several types. The type of pathology directly depends on its pathogenesis 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. The progression of this pathology can be triggered by a mental disorder or bad reflex habits present in the patient. For example, if he suppresses the desire to defecate for a long time for some reason. That is, the problem itself consists in the untimely emptying of the large intestine from feces. This pathology is diagnosed in 3-5% of the total number of certain cases.
3. Obstructive gigantism. The cause of its appearance is a mechanical obstacle that fecal matter encounters on its way to being evacuated from the body.
4. Endocrine megacolon is diagnosed if the cause of the disease is endocrine system diseases. Mainly, such pathological changes as cretinism (caused by a lack 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 identified cases.
5. Neurogenic megacolon is based on organic lesions of the central nervous system. Mainly, such a clinical picture is given by such a disease as meningoencephalitis. Due to pathological changes affecting the nerve endings, there is a general violation of the centers responsible for the 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. Toxic megacolon can develop against the background of taking certain medications or as a result of infectious "aggression" that affects the intramural ganglia of the colon. Pathology of this type is detected in 1-2% of patients diagnosed with rectal gigantism.

Megacolon in children

Congenital megacolon in children is diagnosed in one case per 10-15 thousand children born. Mostly boys suffer from this pathology. From birth, such children may suffer from constipation or complete intestinal obstruction. But in most cases, this begins to bother the baby from the second or third month of his life. Already initially, a progressive increase in the volume of the abdominal circumference can be observed. Basically, the intestine increases its size downwards, and appears slightly shifted to the left.

Megacolon in children is manifested by persistent compaction of fecal matter - spontaneous bowel movement may not be observed for two to three weeks. To prevent this, the intestines are cleansed thanks to a siphon enema given to the patient. The baby suffers from flatulence almost constantly. Gas does not pass completely, accumulating in the intestines. And it is often possible to rid the child's tummy of them only with the help of a gas-discharge tube. There are known cases when long-term constipation was suddenly replaced by atypical diarrhea.

The accumulation of large volumes of feces in the intestines causes vomiting in a fragile organism, which leads to dehydration and intoxication of the body.

When palpating the baby's abdomen, the specialist feels either very dense stool or a softer consistency with fecal stones. When pressing on the baby's tummy at the site of feces, a "dent" can be observed for a certain time (the effect is similar to pressing on a piece of clay). After the process of defecation, which was preceded by a period of stagnation, fecal excrement is very foul-smelling.

This pathology cannot be ignored, as its further progression leads to even more severe pathologies. For example, complete intestinal obstruction, perforation of its walls, perforation of the sigmoid and/or large intestine. And as a final result - developed peritonitis and death.

Functional megacolon in children

Frequent constipation in a child may be associated with the presence of abnormalities in the baby's body that are functional in nature and affect the functionality of the large intestine. Modern statistics have very little knowledge about the frequency of children being affected by the disease in question. This fact is associated with the low sanitary education of the population, when young mothers simply do not know how many times a day their baby should "go to the toilet". In addition, today there are no uniformly 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 one degree or another, with preschool-age children suffering from this pathology three times more often than schoolchildren.

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

The predisposition to functional megacolon in children is directly related to genetic predisposition, burdened by family history.

Most often, the source of gigantism is one or several functional deviations, leading to a failure in the motor-evacuation work of the large intestine. The impetus for pathological disorders is mainly a mismatch in the coordination of propulsive and tonic contractions of the muscles of the walls of the organ in question.

Normal bowel movements in children largely depend on traumatology or post-hypoxic bowel damage. Almost all of the changes that affect an adult can cause functional megacolon in children.

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

Chronic constipation can also take the form of neuroses. This development of pathology is especially characteristic of small children under two years of age, if he does not have normal contact with his mother (he is afraid of her or, on the contrary, his mother, for some reason, had to separate from him for a certain period of time).

For school-age children, the most common cause of problems with defecation is the child's lack of a habit of regular defecation, as well as the suppression of the urge to empty the bowels during lessons, games, and also in the event that a crack has appeared in the intestinal mucosa or the child has a fear of this process.

Functional megacolon in children can also be caused by taking certain pharmacological drugs. The body can show such a response to muscle relaxants (drugs that relax human striated muscles), anticonvulsants, anticholinergics (substances that block the natural mediator acetylcholine). Long-term use of diuretics and laxatives, which wash out potassium from the baby's body and reduce the contractile activity of smooth muscles, can also lead to gigantism of the colon in a child.

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

There are frequent cases when constipation is observed after the baby has had dysentery or another infectious disease, the manifestation of which is profuse diarrhea. Such metamorphoses occur due to the violation of intramural ganglia, which develops on the basis of intestinal dysbacteriosis, caused by a decrease in the amount of "useful" flora.

In our computer age, if small children at least move somehow, then teenagers, largely affected by the “virus” of computerization, are burdened with physical inactivity - such an approach to a child’s regime can lead to a weakening of intestinal motility, and, consequently, to constipation.

Diagnosis of megacolon

In order for the treatment therapy to have a positive result, high-quality diagnostics of megacolon, carried out by a qualified specialist, is necessary.

• Initially, a gastroenterologist or proctologist analyzes the patient's complaints and conducts a visual examination. In this case, he or she pays attention to the enlarged size of the abdomen and its asymmetry.
• The doctor palpates the intestinal loops filled with feces. This simple procedure allows the doctor to feel the density of the feces or differentiated "fecal stones" in it.
• When pressing on the abdomen, a clay effect is obtained. After pressing in the area of the swollen intestinal loop, a dent remains at the place of pressing for some time.
• Collecting the patient's medical history: hereditary predisposition, whether the patient has had infectious diseases, and so on.
• A general radiography of the abdominal organs is performed. This analysis makes it possible to identify enlarged intestinal loops of the colon, a high dome of the pulmonary diaphragm.
• Endoscopic diagnostics.
• Laboratory tests of feces for bacterial flora.
• Obtaining a coprogram. Bacterial culture to identify the underlying infection.
• Blood test for anemia and high white blood cell count.
• If necessary, a colonoscopy or rectoscopy is performed - these two examination methods rather complement each other, allowing for visual examination of the colon. This method, with the connection of endoscopy, allows for taking material for further biopsy.
• Histological examination.
• X-ray contrast irrigoscopy allows the specialist to see narrowed segments of the intestine, above which the intestinal distension is visible. The study allows one to examine circular protrusions of the colon wall, the smoothness of their contours. The result of the analysis can be a diagnosis: megarectum - excessive enlargement of a section of the rectum, megasigma - pathological expansion in the area of the sigmoid colon and megacolon - pathology of the colon as a whole.
• If the analysis reveals the absence of Auerbach's plexus nerve cells in the biopsy material taken from the intestinal mucosa wall, then Hirschsprung's disease is diagnosed.
• A proctologist often prescribes anorectal manometry, the results of which allow assessing the state of the rectal reflex, as well as determining what genesis the megacolon belongs to: congenital pathology or acquired. If structural and physicochemical analyses of the ganglia did not show deviations in its parameters, while the reflexes are preserved, then the disease belongs to acquired pathologies and Hirschsprung's disease is absent.

Megacolon progresses quite slowly in the body of an adult patient, and the symptoms may be slightly blurred and weakly expressed. Therefore, it can be recognized at an early stage of development only with the help of an X-ray examination.

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

Treatment of megacolon

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

Its principle is to maintain regular bowel movements in the patient. To ensure this process, the patient is prescribed a laxative diet, which necessarily includes foods that can enhance peristalsis. This is a group of fermented milk products, dishes from table beets, carrots, apples, bran, prunes and many others.

Massages of the abdominal cavity are quite effective. Using the palm of the hand (for children) or a clenched fist (or a towel wrapped around the upper limb for adults), make pressing circular movements. The movement starts from the top of the abdomen and is carried out clockwise (in the direction of the natural movement of feces). The massage should be done 10-15 minutes before each meal.

Physical therapy, which is directly aimed at increasing the tone of the abdominal muscles, is also quite effective.

The doctor may recommend that in order to soften the stool, adult patients drink two to three tablespoons of vegetable oil three times a day, and children one tablespoon once a day.

Treatment of megacolon does not allow taking medications that have a laxative effect. Some patients, self-medicating, prescribe such medications. With prolonged use, such patients have to constantly increase the dosage of the administered drug, which only worsens the health situation, and can also provoke intestinal obstruction.

Before undergoing surgical treatment, a patient diagnosed with megacolon has to make do with regular enemas. They can be of different types: hypertonic, siphon, Vaseline and cleansing. The doctor prescribes based on the clinical picture of the disease and the patient's health during the period of therapy. For example, it is very important for cleansing and siphon procedures that the water administered is at room temperature. If it has a higher temperature, it is better absorbed by the mucous membrane, which can only worsen the situation (especially with toxic megacolon).

Immediately after the cleansing procedure, a tube is inserted to remove gases and remaining liquid.

If the patient is hospitalized in a critical condition, the first thing they try to do is to reduce the volume of the intestines to prevent perforation and the development of peritonitis. To do this, a tube is inserted into the intestines through the patient's nasal or oral cavity to remove the accumulated fluid and gas. If necessary, a blood transfusion is performed. The patient receives nutrition through intravenous drips.

Antibiotics may be used in therapy. Their task is to stop the existing accompanying pathogenic flora or blood poisoning caused by developing sepsis.

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

Bificola colibacterin is prescribed for oral administration half an hour before meals. Depending on the patient's age and the severity of the pathology, the doctor prescribes one to five doses taken twice a day. The duration of treatment is from two to three weeks. If necessary, the course of therapy is repeated, but not earlier than after two months.

Contraindications to taking the drug are individual intolerance to the components of the drug, as well as a history of specific and non-specific ulcerative colitis.

Enzyme medicines are prescribed to improve the functioning of the digestive system. For example, pancitrate, pancreatin, mezim, pancrol, panzinorm forte-N, penzital, festal-P and others.

Mezim is prescribed to adult patients one or two pills, which are taken immediately before meals. Contraindications to taking the drug are inflammation of liver tissue, increased intolerance to the components of the drug, mechanical jaundice.

Prokinetics of colon motility modulators: motilak, damelium, motonium, domstal, motinorm, domet, passazhiks, domperidone, motilium, domperidone, hexal.

Motonium is administered orally half an hour before meals. The recommended average dosage for children over five years of age is 10 mg, taken three to four times a day. If necessary, another dose can be administered immediately before bedtime. If there are medical indications, the amount of the drug administered at one time can be doubled, the number of doses remains the same.

For patients with renal dysfunction, the dose should be adjusted and the number of administrations should not exceed one or two times.

It is not recommended to take this medicine in case of gastric bleeding, hypersensitivity of the patient's body to the components of the medicine, intestinal obstruction, perforation of the mucous membrane of the digestive tract, as well as for children under five years of age or weighing less than 20 kg.

Often, the doctor also prescribes electrostimulation of the rectum - the impact of small currents on the affected organ. Such irritation makes the intestines activate and improve their functioning.

Surgical treatment of megacolon

Surgical intervention is prescribed in cases where conservative treatment is unable to effectively resolve the problem. Surgical treatment of megacolon involves excision of the affected section of the intestine, and the remaining "healthy" parts are connected to each other.

There are cases when this cannot be done in one operation, then the upper section of the colon has to be brought out through the abdominal cavity. Colostomy can be either permanent (and the patient has to live with it for the rest of his life, using special devices for the process of defecation - colostomy bags), or temporary (when a repeat operation is performed to reconstruct the colon).

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

After the surgical intervention, the patient undergoes postoperative recovery using drug therapy, which includes antibiotics, anti-inflammatory drugs and a vitamin-mineral complex, and nutritional adjustments. Rehabilitation is also due to special exercises of therapeutic physical training, which are designed to improve the state of intestinal muscle tone and strengthen the abdominal muscles.

Subsequently, after surgical treatment, the patient remains under the supervision of a qualified specialist for another one to one and a half years.

Prevention of megacolon

Any prevention of the disease is the protection of your body from pathology or at least the relief of its symptoms. Prevention of megacolon consists, first of all, in proper and balanced nutrition. The diet of any person should contain a sufficient amount of food products that liquefy feces (but you should not get carried away with them, everything should be in moderation), as well as products with a high fiber content that stimulate the nerve endings of the intestinal walls, making them work more actively. Stewed and raw fruits and vegetables, fermented milk products are welcome. Then it is worth reducing the amount of jelly, sweets, fresh pastries, viscous porridge consumed.

It is necessary to lead an active lifestyle, hypodynamia is an ally of megacolon. It is worth getting rid of bad habits: alcohol, drugs and nicotine will not add to health. Massages and therapeutic physical training will strengthen the abdominal muscles and the muscles of the intestinal walls and sphincter.

Megacolon prognosis

The answer to this question is ambiguous and depends on the patient's condition, as well as the severity of the disease that has 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 prognosis for megacolon is quite deplorable. With poor care, intestinal obstruction, infectious damage and exhaustion of the body are added to the main anamnesis - this is a 100% fatal outcome.

Less common are cases of death from peritonitis, which develops against the background of perforation of the intestinal walls.

But if the disease was diagnosed in an early stage and adequate treatment was administered, the prognosis for megacolon is quite optimistic. After treatment, a person continues to live a full life.

Look at what a modern person eats. Accustomed for centuries to other food, our digestive tract is unable to cope with the amount of "chemistry" that gets into it, reacting with various pathological changes. One of the most common deviations from the norm is constipation, which, if no countermeasures are taken, can subsequently lead to the development of such a pathology as megacolon. In such a situation, there is only one piece of advice: "Dear respondents, take a closer look at your diet! Only you yourself can save your health and life!" If signs of constipation appear, and it appears with regular consistency, then do not delay in visiting a specialist.