What is it - intestinal dolichosigma? This is an abnormal lengthening of the sigma, in which the wall thickness does not change, the diameter of the intestine also remains normal, and the length increases. At the same time, sigma becomes pathologically mobile and does not allow the stool to form and move normally, motility and emptying are disturbed. Due to its increased length, it can twist, fold into loops. The normal length of the sigma is 24-46 cm, with pre-chilosigma it exceeds 46 cm and forms an extra 2-3 loops.
Essence of pathology
Dolichosigma in a child may not manifest itself in any way, and some doctors attribute this to the characteristics of the body. If such a sigma causes constipation and pain, gas formation and intoxication of the body, then this is already a disease.
Constipation in young children is a very common occurrence, it is a problem of parents and pediatricians. But most often this phenomenon is associated with nutrition, especially in artificers. If constipation becomes permanent, it isindicates disorders of the lower intestine.
Dolichosigma according to ICD-10
Dolichosigma in children according to ICD-10 does not have its own separate code. She has one code with the group "Other congenital anomalies of the intestine", with pathologies such as caecum syndrome, intestinal diverticula, dolichocolon, microcolon, megaloappendix, transposition of the appendix, megaloduodenum - Q 43.8.
Appearance mechanism
So what is this - intestinal dolichosigma? It is acquired and congenital. For children, the second option is characteristic, pathology occurs even during embryogenesis. In this case, the sigma has 2-3 extra loops.
Acquired variant occurs in adults over 45, mainly in those who lead a sedentary lifestyle and love fatty foods. Why dolichosigma occurs in a child has not yet been clarified. Some talk about bad heredity. Other occurrences of dolichosigma in a child during the neonatal period are associated with infectious diseases during pregnancy or the expectant mother taking some medications. There is also no consensus on whether the pathology is a malformation of the final intestine.
Some researchers consider pathological sigma to be a variant of the norm, because it is often common and is found in 25% of children who do not present any complaints. But in contrast to this opinion, there is another thing - the disturbed length of the sigma is often accompanied by an organic or functional deviation in the structure of the final section of the sigma and rectum. ItIt is expressed in chronic inflammation of the mucosa, intestinal stasis, an increase in muscle fibers, thickening of the mesenteric tissue, damage to the intramural nerve ganglia and a violation of cellular metabolism. In other words, dolichosigma leads to degenerative lesions of the intestine and disrupts its work.
Main causes of occurrence
Causes unknown, but predisposing factors identified:
- pregnancy complications;
- infections during gestation;
- hypovitaminosis and protein deficiency in the mother's diet;
- bad ecology during mother's pregnancy - increased background radiation, gas pollution, poor quality of drinking water;
- bad heredity;
- medication during pregnancy.
Symptomatic manifestations
In 70% of cases, symptoms appear before the year. In 30% of cases, stool disorders occur at 3-6 years of age. The first symptoms of dolichosigma in children usually appear at 6 months. Constipation and stagnation of feces immediately occur with the introduction of the first complementary foods, with the transition to artificial feeding.
Constipation becomes the main symptom. The rest of the clinic develops gradually. It manifests itself in capriciousness, lethargy, crying, refusal to breast or food, poor sleep and screaming during the day. The symptoms subside only when the child goes to the toilet. A decrease in local immunity is manifested by small pustules on the skin.
There is no stool for 3-4 days, and bowel cleansing becomes a problem. At first, a bowel movement happens every 3days, then once a week, and later a month.
Stagnation of feces poisons the body, it thickens, increases and acquires a fetid smell of decay. Solid feces, with their slow progress, injure the mucous membrane, blood begins to mix with them. The sigma is stretched, and its walls become thinner. This may result in perforation. If enemas are constantly used, the voiding reflex decreases.
Older children show symptoms as follows:
- abdominal pain around the navel or on the left;
- constipation;
- nausea;
- brittle nails;
- jaws in the corners of the mouth;
- weight loss and loss of appetite (hypovitaminosis);
- pale face;
- blue lips;
- flatulence;
- rumble;
- bad breath;
- accession of gastritis, chronic pancreatitis, colitis, hemorrhoids.
Child seems tired, often refuses to eat, has a fast heartbeat, refuses to play. Due to constipation and pain, the child is afraid to ask to go to the toilet. Symptoms are especially aggravated after a large meal or exercise.
Course of disease
Dolichosigma takes place in three stages or forms with different severity of manifestations:
- The compensation stage is the initial and easiest. Constipation is not always disturbing, they happen for 3-4 days, they go away after defecation, the pain is not strong. The general condition does not change, the child is quite active. The stage is easily treated with diet and laxatives.
- Subcompensation stage - stool is also missing anymore3 days, but now permanently. The abdomen is swollen, it hurts. The kid eats poorly, does not gain weight and is irritable. Laxatives are not enough, you have to use enemas. The first signs of intoxication of the body appear.
- Decompensation stage - all symptoms are bright, running. Constipation is prolonged, intoxication is pronounced: headaches, poor appetite, skin rashes, nausea and vomiting, anemia and lethargy. The abdomen is swollen constantly and hurts all the time. Emptying once a week or a month. There may be signs of partial intestinal obstruction. Enemas have to be used only siphon. Effective treatment is only surgical.
Diagnostic measures
The diagnosis of dolichosigma in children is made after a comprehensive examination of blood, feces, instrumental research methods. First, a visual examination reveals a lack of weight and pallor of the child, peeling of the skin on the fingers due to beriberi.
Palpation feels that the stomach is full in the loops. A digital examination shows that the rectum is empty.
Irrigography will help to identify the degree and number of loop curls, the magnitude of the sigma. Additional loops can be in the form of "eight", "snail", "knot".
CT is used for diagnosis in older children. This technique allows you to determine volumetric formations. CT scans are not possible for young children due to their mobility.
Ultrasound, X-ray, irrigoscopy, colonoscopy, general and biochemical blood tests, fecal analysis for worm eggs and the presence of occult bleeding are also prescribed. Intestinal ultrasoundfilled with hard feces. What do the reviews say about the examination of dolichosigma in a child? Many parents worry that this procedure causes discomfort and pain to the baby. Many mothers categorically do not go for examination precisely because the child is simply unable to endure the procedures and is afraid. Others believe that the barium used for barium enema will cause infertility in the girl in the future. Some consider barium to be disgusting, and even an adult would not drink it.
All these fears are groundless. Many tolerate the procedure easily. Moreover, during colonoscopy, for example, children are given short anesthesia.
Complications of dolichosigma
In the absence of attention and treatment, it is noted:
- delayed physical development;
- anemia;
- pustular skin diseases;
- intestinal obstruction due to fecal stones;
- fecal intoxication.
Principles of Therapy
Treatment of intestinal dolichosigma in children is done by a pediatric gastroenterologist.
Goal of therapy:
- Stool normalization.
- Improve stool density.
- Restarting bowel function by stimulating the gastrointestinal tract.
- Removal of acute inflammation.
For crushing fecal stones, abdominal massage and therapeutic exercises are used. This leads to a rush of blood to the intestines and strengthens the abdominal muscles. To improve the functioning of the intestines, physiotherapy is prescribed. Treatment begins with diet and nutrition.
Special Diet
It is necessary to provide water and drinking regime. You should drink at least 10 glasses of water per day. Nutrition should be fractional - 5-6 times a day, in small portions, strict in time. Water with lemon helps to loosen the stool. Meat is forbidden, a glass of 1% kefir is required.
Child's menu with dolichosigma: more foods with fiber (berries, herbs, fruits). Their heat treatment is necessary - boiling or steaming. Everything that is covered with a delicious crust, as well as fried, smoked, spicy, is excluded. Dishes that slow down the movement of feces through the intestines are also contraindicated - rice, semolina, millet, pasta, white bread, muffins, cookies and cakes, coffee, cocoa, strong tea. Animal fats increase fermentation and are poorly digested. Regarding chocolate: it can be given rarely, not an hour before meals and after it.
You can give your child fish, cottage cheese, dairy products, buckwheat porridge, salads, vegetarian soups. Bran is recommended, beets, prunes, carrots, figs, pumpkin, baked apples, apricots, plums, dried apricots are shown from vegetables and fruits. From sweets you can compotes, limited honey, marmalade (contains pectins).
Bananas, grapes and pears are excluded. Due to the limited choice of products, the diet for dolichosigma in children is supplemented with multivitamins containing C, A, E, group B, D. They will support immunity.
Medicated treatment
Clinical guidelines for dolichosigma in children include:
- Herbal enemas, laxatives (fecal volume increases), prokinetics, means to reducekala.
- "Motilium". It speeds up the evacuation of the food bolus. He is scheduled for 2 weeks.
- If the diet does not work, laxatives are used, and they start with minimal doses.
- Pain in the abdomen and flatulence is removed by "Dibazol" and "Prozerin" in injections. "Proserin" also increases the tone of the intestinal walls. The effect increases many times if it is combined with electrical stimulation of the large intestine.
- Anspasmodics are ineffective, because the pain is not caused by spasm, but by intestinal atony.
- An important step is to improve the intestinal microflora, for which pre- and probiotics are prescribed: Bifidumbacterin, Lactobacterin, Narine, Linex, etc.
- In the medical treatment of intestinal dolichosigma in children, the doctor prescribes "Duphalac", "Psyllium", "Mukofalk" (these drugs are from the shell of psyllium seeds), "Duspatalin", "Festal" to improve well-being. Their action is multilateral: increased tone of the intestinal wall, liquefaction of feces, increased intestinal motility.
The effect of treatment can be enhanced by herbal decoctions and infusions, but only after consulting a doctor. Drugs are also used to reduce flatulence, to reduce the smell of feces.
Physiotherapy Methods
Physiotherapy for dolichosigma in children is valuable because it can normalize bowel function. The following are considered effective:
- electrical stimulation of the intestine for 2 weeks with prolonged constipation;
- laser therapy;
- acupuncture;
- electrophoresis with tonic substances.
Attitude towards colon hydrotherapy is negative due to many complications.
Using enemas
An enema is done with clean water or saline solution, chamomile decoction. The urge to void occurs as a reflex. The volume of water depends on the age of the child. The temperature of the solution should not differ from the temperature of the baby's body.
The baby is placed on the right side, the tip of the enema must be lubricated with vaseline oil. After the fluid is injected, the buttocks should be squeezed and the baby should be held in your arms for 10 minutes, after which the baby should be put on the potty.
Enemas, even if they are effective, should be used as little as possible, it is better to form a reflex to defecate so that going to the toilet is calm.
What is the benefit of massage
Massage for dolichosigma in a child is an obligatory component of treatment. It is not done only with blood in the stool. Babies need a back and belly massage daily to strengthen their muscles.
Procedures are carried out when laying the baby on the stomach. With two fingers, carefully make spiral movements along the spine from the lower back and down to the coccyx. The abdomen is massaged in circular motions clockwise. Massage should be pleasant for the child, otherwise there will be no other results than screaming and crying.
The beginning and end of the procedure - in the form of stroking and rubbing. Massage movements should be slow,pressing.
Tapping with finger phalanges in reverse order. The entire procedure takes at least 20 minutes. It is better to massage in the morning, before feeding.
Therapeutic exercise is shown to older children. It is better if these are group classes, where the kids look at each other. Then they repeat the movements of their neighbors and learn faster. Stimulate the work of the intestines also jumping in place with a rope, running, spinning a hoop.
Surgery
If various methods of conservative treatment do not reveal positive results and the disease continues to progress, there is addiction to enemas, intoxication is pronounced and continues to grow, resort to radical methods of treatment.
An operation for dolichosigma in a child can be recommended by the attending physician only in extreme cases.
Indications for surgery:
- lack of positive dynamics from conservative treatment;
- pronounced intoxication;
- intestinal obstruction;
- pressing part of the pipe into another - "wrapped stocking";
- sigma twists, spikes and kinks;
- presence of fecal stones.
The operation is performed only at the 3rd stage of the disease. Contraindications to surgery: severe pathologies of the central nervous system and cardiovascular system.
Surgery is performed under general anesthesia. Unnecessary loops of the sigmoid colon are cut off and the ends are sutured - upper and lower.
Sigma resection surgerycalled a proctosigmoidectomy. If intestinal obstruction is suspected, the entire intestine is examined, because the twisting of the movable loops compresses and disrupts the nutrition of the intestinal wall, causing tissue necrosis. Then part of the excess sigma and other sections of the intestine are removed.
Duration of operation 1.5 hours. Removing excess loops allows feces to pass through the intestines normally. After a disease, spa treatment is very useful for better and faster recovery.
What are the forecasts
Diet, taking prescribed medications will definitely help the child in the first two stages. This will make the stool regular.
At stage 3, the decision is individual, it is determined by a number of factors. Complications arise when the process is ignored anyway. Ultimately, fecal masses are formed, which can no longer come out on their own. At the same time, food waste rots and the body is poisoned. The prognosis in such cases is unfavorable.
Prevention measures
As a preventive measure, a diet consisting of fermented milk products and light salads is recommended. You should drink plenty of water, be active, walk a lot in the fresh air.
After eating, a massage of the abdomen is desirable, especially for babies. Food should be fractional, without overeating. According to many parents, problems with stools in the summer in a child disappear or noticeably decrease. Good reviews about Microlax and Dufalac.
