What is intestinal dolichosigma? This is an abnormal lengthening of 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 stool masses to form and move normally, motility and emptying are impaired. Due to its increased length, it can twist, fold into loops. The normal length of sigma is 24-46 cm, with dochilosigma it exceeds 46 cm and forms an extra 2-3 loops.
The essence of pathology
Dolichosigma in a child may not manifest 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 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, this indicates a violation 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 cecum syndrome, intestinal diverticula, dolichocolon, microcolon, megaloppendex, appendix transposition, megaloduodenum - Q 43.8.
Appearance mechanism
So what is intestinal dolichosigma? It is acquired and congenital. For children, the second option is characteristic, pathology occurs even during embryogenesis. At the same time, sigma has 2-3 extra loops.
The acquired option is found in adults after 45 years, mainly those who lead a sedentary lifestyle and love fatty foods. Why dolichosigma occurs in a child has not been clarified so far. Some speak of poor heredity. Other occurrences of dolichosigma in a child during the neonatal period are associated with infectious diseases during pregnancy or the use of some drugs by the expectant mother. There is also no consensus on whether pathology is a defect in the formation of the final section of the 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 have no complaints. But in contrast to this opinion, there is another thing - the broken sigma length is often accompanied by an organic or functional deviation in the structure of the final section of sigma and rectum. It is expressed in chronic inflammation of the mucosa, intestinal stasis, an increase in muscle fibers, densification of the mesenteric tissue, damage to the intramural nerve ganglia and impaired cellular metabolism. In other words, dolichosigma leads to degenerative lesions of the intestine and disrupts its work.
The main reasons for the appearance
The reasons are unknown, but predisposing factors are established:
- pregnancy complications;
- infections during gestation;
- hypovitaminosis and protein deficiency in maternal nutrition;
- poor ecology during maternal pregnancy - increased background radiation, gas contamination, poor quality of drinking water;
- bad heredity;
- taking medication during pregnancy.
Symptomatic manifestations
In 70% of cases, symptoms appear up to a year. In 30% of cases, stool disorders occur in 3-6 years. 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 feeding, during the transition to artificial feeding.
Constipation becomes the main symptom. The rest of the clinic is developing gradually. It manifests itself in moodiness, lethargy, crying, refusing to breast or eat, bad sleep and screaming during the day. Symptoms subside only when the child goes to the toilet. Decreased local immunity is manifested by small pustules on the skin.
There is no stool for 3-4 days, and bowel cleansing becomes a problem. First, bowel movements occur once every 3 days, then once a week, and later in a month.
Stagnation of feces poisons the body, it becomes denser, increases and acquires a fetid smell of decay. Solid feces during their slow advance injure the mucous membrane, blood begins to mix with them. Sigma is stretched, and its walls are thinning. This may result in perforation. If enemas are constantly used, the emptying reflex decreases.
In older children, symptoms appear as follows:
- abdominal pain around the navel or on the left;
- constipation
- nausea;
- fragility of nails;
- seizures in the corners of the mouth;
- weight loss and loss of appetite (hypovitaminosis);
- pallor of the face;
- cyanosis of the lips;
- flatulence;
- rumbling;
- bad breath;
- accession of gastritis, chronic pancreatitis, colitis, hemorrhoids.
The child seems tired, he often refuses to eat, he has a rapid heartbeat, he refuses to play. Due to constipation and pain, the child is afraid to ask for a toilet. Especially the symptoms worsen after a large portion of food or exercise.
Course of the disease
Dolichosigma passes in three stages or forms with different severity of manifestations:
- Compensation stage - initial and easiest. Constipation is not always disturbing, it happens for 3-4 days, go away after bowel movements, and the pains are mild. The general condition does not change, the child is quite active. Stage is easily treated by diet and laxatives.
- Subcompensation stage - the chair is also absent for more than 3 days, but now it is permanent. Belly swollen, sore. The kid eats poorly, does not gain weight and is irritable. Laxatives become insufficient, enemas have to be used. The first signs of intoxication appear.
- Stage of decompensation - all symptoms are bright, running. Constipation is long, intoxication is expressed: headaches, poor appetite, skin rashes, nausea and vomiting, anemia and lethargy. The stomach is bloated constantly and hurts all the time. Emptying once a week or per month. There may be signs of partial bowel obstruction. Enemies 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 methods of research. First, a visual examination reveals a child’s weight deficit and pallor, peeling of the skin on the fingers due to vitamin deficiency.
Palpation is felt that the stomach is full in loops. A digital examination shows that the rectum is empty.
Irrigography will help to identify the degree and number of loop curls, the size of the sigma. Additional loops can be in the form of a figure eight, snail, knot.
For diagnosis in older children, CT is used. This technique allows you to determine the volumetric formation. CT cannot be performed on young children due to their mobility.
Ultrasound, X-ray, irrigoscopy, colonoscopy, general and biochemical blood tests, feces for worm eggs and the presence of hidden bleeding are also prescribed. On ultrasound, the intestine is clogged with dense feces. What do the reviews say about the examination of dolichosigma in a child? Many parents worry that this procedure causes the baby discomfort and pain. Many mummies categorically do not go for examination precisely because the child is simply unable to tolerate the procedures and is afraid. Others believe that barium, used for irrigoscopy, will cause infertility in the girl in the future. Some consider taking barium disgusting, and an adult will not drink it either.
All these fears are groundless. Many endure the procedure easily. Moreover, during colonoscopy, for example, children are given a 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
A pediatric gastroenterologist is involved in the treatment of intestinal dolichosigma in children.
The purpose of therapy:
- Normalization of bowel movements.
- Establishing the density of the stool.
- The resumption of intestinal stimulation of the digestive 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 muscles of the abdomen. To improve the functioning of the intestine, physiotherapy is prescribed. Treatment begins with a diet and a diet.
Special diet
It is necessary to ensure a water-drinking regime. You should drink at least 10 glasses of water per day. Food should be fractional - 5-6 times a day, in small portions, strict in time. Water with lemon helps, which dilutes 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 needed - boiling or steaming. Everything that is covered with a delicious crust, as well as fried, smoked, spicy, is excluded. Also, dishes that slow down the movement of feces in the intestines are contraindicated - rice, semolina, millet, pasta, white bread, muffin, cookies and cakes, coffee, cocoa, strong tea. Animal fats enhance fermentation and are poorly absorbed. Regarding chocolate: it can be given rarely, not an hour before and after meals.
You can give your child fish, cottage cheese, dairy products, buckwheat, salads, vegetarian soups. Bran is recommended; beets, prunes, carrots, figs, pumpkin, baked apples, apricots, plums, dried apricots are shown from fruits and vegetables. From sweets you can stew, limited to honey, marmalade (contains pectins).
Bananas, grapes and pears are excluded. The diet for dolichosigma in children due to the limited choice of products is supplemented with multivitamins containing C, A, E, group B, D. They will support the immune system.
Drug treatment
Clinical recommendations for dolichosigma in children include:
- Enemas are herbal, laxatives (increase fecal volume), prokinetics, means to reduce feces.
- Motilium. It speeds up the evacuation of the food lump. He is prescribed for 2 weeks.
- In the absence of the effect of the diet, laxatives are used, and begin with minimal doses.
- Abdominal pain and gas formation are relieved by Dibazolum and Proserinum in injections. Proserin also increases the tone of the intestinal wall. The effect increases significantly if it is combined with electrical stimulation of the large intestine.
- Antispasmodics are ineffective, because the pain is caused not by spasm, but by intestinal atony.
- An important step is the improvement of the intestinal microflora, for which pre- and probiotics are prescribed: Bifidumbacterin, Lactobacterin, Narine, Linex, etc.
- During medical treatment of intestinal dolichosigma in children, the doctor prescribes Dufalac, Psillium, Mukofalk (these preparations are from the plantain seed coat), Duspatalin, and Festal to improve well-being. Their action is multilateral: increasing the tone of the intestinal wall, liquefying feces, increasing intestinal motility.
The effect of treatment can be enhanced by herbal decoctions and infusions, but only after consulting a doctor. They also use drugs to reduce flatulence, to reduce the smell of feces.
Physiotherapy Methods
Physiotherapy with dolichosigma in children is valuable in that it can normalize the intestines. Effective are:
- intestinal electrical stimulation for 2 weeks with prolonged constipation;
- laser therapy;
- acupuncture;
- electrophoresis with tonic substances.
The attitude to hydrocolonotherapy is negative due to many complications.
Using enemas
Enema is done with pure water or saline, a decoction of chamomile. The call for emptying arises as a reflex. The volume of water depends on the age of the child. The temperature of the solution should not differ from the baby's body temperature.
The baby is placed on the right side, the enema tip must be lubricated with liquid paraffin. After the introduction of the liquid, the buttocks should be squeezed and carried on the child’s hands for 10 minutes, after which the baby must be landed on the pot.
Enemas, even with their effectiveness, should be used as rarely as possible, it is better to form a reflex to bowel movements so that the toilet is calm.
What is useful massage
Massage with dolichosigma in a child is an essential component of treatment. It is not done only with blood in the stool. Breasts need a back and abdominal massage daily to strengthen their muscles.
Procedures are carried out when laying the baby on the stomach. Using two fingers, carefully make spiral movements along the spine from the lower back and down to the coccyx. The stomach is massaged in a circular motion clockwise. The massage should be pleasant to the child, otherwise, apart from screaming and crying, there will be no other results.
The beginning and end of the procedure is in the form of stroking and rubbing. The movements during massage should be slow, pressing.
In the reverse order, tap the phalanges of the fingers. The whole procedure lasts at least 20 minutes. It is better to massage in the morning, before feeding.
Physiotherapy exercises are indicated for older children. It is better if it will be group classes, where the kids look at each other. Then they repeat the movements of their neighbors and learn faster. Stimulating the intestines also jumping in place with a skipping rope, running, spinning a hoop.
Surgical intervention
If various methods of conservative treatment do not reveal positive results and the disease continues to progress, there is addiction to enemas, intoxication is expressed and continues to increase, resorting to radical methods of cure.
The doctor may recommend surgery for dolichosigma in a child only in extreme cases.
Indications for surgical intervention:
- lack of positive dynamics from conservative treatment;
- severe intoxication;
- intestinal obstruction;
- pushing part of the pipe into another - “wrapped stocking”;
- twists, adhesions and excesses of sigma;
- the presence of fecal stones.
The operation is performed only at the 3 stages of the disease. Contraindications for surgery: severe pathology of the central nervous system and cardiovascular system.
Surgery is performed under general anesthesia. Cutting off unnecessary loops of the sigmoid colon and stitching the ends - upper and lower.
Sigma resection surgery is called proctosigmoidectomy. If intestinal obstruction is suspected, the entire intestine is revised, 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 parts of the intestine are removed.
The duration of the operation is 1.5 hours. Removing excess loops allows feces to normally pass through the intestines. After a disease, a spa treatment is very useful for a better and faster recovery.
What are the forecasts
Diet, taking prescription drugs will help the child in the first two stages clearly. In this case, the chair will become regular.
At stage 3, the decision is individual, it is determined by a number of factors. Complications arise when you ignore the process anyway. Ultimately, fecal masses are formed that can no longer independently go out. At the same time, rotting food waste and poisoning of the body occur. The prognosis in such cases is unfavorable.
Preventive actions
As a preventive measure, a diet consisting of fermented milk products and light salads is recommended. You should drink a lot 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 stool in the child in the summer pass or significantly decrease. Good reviews about Microlax and Dufalac.