The morphological study of the resected sections of the colon obtained at the S.P. Fedorov Department of Faculty Surgery of S.M. Kirov Military Medical Academy, as a result of surgical treatment of patients with severe chronic slow-transit constipation, included an assessment of the changes in the structures of ganglion plexuses. Three cases were considered (women, aged 3740 years). Various degrees of pathological changes were detected in the ganglion plexuses (Auerbach and Meissner) of the sigmoid colon from patients with chronic slow-transit constipation using Nissls toluidine blue staining. In all cases, reactive, dystrophic, severe degenerative-necrotic changes of ganglion cells, as well as the details of their death, were described in detail. Along with pathological changes in nerve cells in the myenteric nerve plexus and gliosis, features of neuronglial relationships were described, and the death of ganglion cells in the human colon with the active participation of specialized astrocyte-like glial cells was also established for the first time. In the third case, a pattern of pronounced dysplasia and dysgangliogenesis was revealed in the myenteric ganglion plexus of the sigmoid colon, and the presence of diffuse lymphmonocytic infiltrates was noted in the circular muscle layer. Pathological changes in the enteral nervous system in chronic slow-transit constipation reflect neuropathy, which can serve as the main cause of impaired intestinal functions and of some symptoms.

The purpose of this study is to determine the distribution and features of sympathetic innervation of the tissues of the human colon wall in chronic slow-transit constipation using immunohistochemical methods. Materials and methods. Immunohistochemical study of large intestine segments (colon and sigmoid colon) obtained as a result of surgical treatment of patients with chronic slow-transit constipation was carried out using neural markers (PGP 9.5 protein, tyrosine hydroxylase, synaptophysin). Results. It has been shown that the majority of postganglionic sympathetic nerve fibers are localized in the Auerbach and Meissner plexuses. Their terminal axons form pericellular synaptic apparatuses around cholinergic neurons. Another part of the sympathetic fibers is involved in the innervation of the muscular plate of the mucous membrane and the walls of the venous vessels of the submucosa; their terminal varicose axons can be seen on smooth muscle cells as distant synapses en passant. Significant features of sympathetic innervation disorders of the large intestine of the studied patients were established; morphological evidence for the reactive, dystrophic and degenerative changes in the sympathetic apparatuses in the ganglionic plexuses were found. The regularities of the absence of sympathetic innervation in two muscle layers (longitudinal and circular), as well as in the mucous membrane, were revealed. Sympathetic neurons were not found in the studied sections of the large intestine. Conclusion. It is assumed that the identified pathological changes in sympathetic innervation in chronic slow-transit constipation can serve as one of the main causes of disruption of normal bowel functions.

Introduction. To select an appropriate and informative histological method is a very important step in morphological analysis of the digestive organs, one of them being immunohistochemistry. The aim of this paper was to highlight the most effective immunohistochemical markers in addition to the well-known markers used in pathological diagnosis. Materials and methods. We studied sections of the intestine and pancreas of Wistar rats (n=20) and fragments of the human colon obtained during resection surgeries (n=4). We described and analyzed the results of immunohistochemical studies with neuronal and glial marker antibodies and inflammatory cells antibodies. Results. Neural (PGP 9.5 protein, tyrosine hydroxylase, synaptophysin, and serotonin) and glial markers (glial fibrillar acidic protein and S100 protein) enable for identifying all of the nervous structures in the murine digestive system such as neurons, nerve trunks and bundles, nerve plexuses, and terminals. Macrophage markers (CD68, Iba1) and mast cell marker (mast cell tryptase) can be applied to study the inflammatory process in the intestinal tissue. We described the key features of primary antibodies and fixative agents used in histopathology. Conclusion. We have shown that the described method is a promising assessment technique for histological studies of the intestine and pancreas pathologies. It can be used in diagnosing conditions associated with inflammation and neurodegeneration. Keywords: duodenum, colon, pancreas, rat, human, innervation, inflammation, immunohistochemistry

Surgical treatment of patients with chronic slow-transit constipation leads to unsatisfactory results in almost a third of cases. It appears relevant to the search for the causes of unsatisfactory results of surgical interventions in such patients and the need to develop a rational diagnostic algorithm; its implementation will allow us to determine the indications for surgical treatment and justify the volume of colon resection. For this purpose, the results of the examination and treatment of 53 patients with constipation were analyzed. The median disease duration was 15 years, and the median duration of constipation was 6.2 1.6 days. Patients were divided into a group with a positive effect of conservative treatment and a group without the expected effect. The symptoms, results of laboratory tests of blood and feces, and instrumental studies of the colon were analyzed. A balloon expulsion test was used to exclude proctogenic constipation. The evacuation function of the colon was studied by X-ray examination, while the transit time of barium sulfate or X-ray contrast markers through the gastrointestinal tract was estimated. Twenty-four patients underwent surgery for chronic slow-transit constipation, while the sigmoid colon was removed in one patient, including 7-left-sided hemicolectomy and 16-subtotal resection of the colon. Long-term results were examined in the period from 3 to 6 months after surgery. In the total examination of the semiotics of chronic slow-transit constipation, the results did not show significant differences between the groups of patients and did not allow us to justify the stratification into severe and non-severe disease course by its specific symptoms. The use of X-ray contrast markers for the assessment of the state of the evacuation function of the colon makes it possible to quantify the severity of various motor disorders and justify the choice of the volume of its resection. The analysis of the long-term results of the treatment of patients with chronic slow-transit constipation allows us to conclude that segmental resections of the colon (left-sided hemicolectomy, resection of the sigmoid colon) have a good therapeutic effect if the preoperative examination revealed a segmental type of failure of the evacuation function of the colon, and subtotal resection of the colon is appropriate for the common type. The absence of negative results of surgical treatment of patients with chronic slow-transit constipation, in which the formation of a colonic anastomosis was performed with a short stump of the sigmoid colon, indicates the possibility of using this option to complete the surgical intervention.