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Chronic constipation is one of the most urgent problems in modern coloproctology and is observed in 14–16% of the population of developed countries. The causes of chronic constipation vary widely from functional to organic. The latter include various variants of dolichocolon, which occur in 16% of cases.The aim of the study was is to give a morphological and quantitative characteristic of subcompensated dolichocolon based on the morphogenesis of changes, compared with histologically normal colon.Material and methods. Colon tissue samples from 15 people were used, which were divided into two groups. The first, control group consisted of 5 sectional cases of a morphologically normal colon wall. The second group was represented by the surgical material of 10 patients with subcompensated dolichocolon. Observation groups were representative by sex and age.Results. In patients with subcompensated dolichocolon, compared with the control group, the thickness of the mucosa in the colon wall is statistically significantly (p=0.034) reduced by 1.06 times, which indicates atrophy; the thickness of the submucosal layer increases by 1.55 times due to edema with foci of sclerosis (p=0.0001); the thickness of the muscle layer increases by 1.16 times (p=0,0003), because of working hypertrophy and compensatory hyperplasia of smooth muscle cells; at the same time, the number of nerve cells in Auerbach's plexuses decreases by 1.59 times (p=0,0001), which will lead to atrophy of the muscle layer and decrease its evacuator-motor function; the average area of lymphoid follicles increases by 1.35 times (p=0,003) and the percentage of secondary follicles decreases 8 times (p=0,0001), which is a consequence of congestion of intestinal contents and activation of the intestinal lymphoid apparatus.Conclusion. Morphological signs of atrophy and sclerosis changes of the cellular elements of the colon neuromuscular apparatus begin to form at the subcompensated stage of dolichocolon, which requires new objective clinical and morphological indications for surgical treatment of patients in order to prevent the development of decompensation of the patients’ general condition and severe complications.
Chronic constipation is one of the most urgent problems in modern coloproctology and is observed in 14–16% of the population of developed countries. The causes of chronic constipation vary widely from functional to organic. The latter include various variants of dolichocolon, which occur in 16% of cases.The aim of the study was is to give a morphological and quantitative characteristic of subcompensated dolichocolon based on the morphogenesis of changes, compared with histologically normal colon.Material and methods. Colon tissue samples from 15 people were used, which were divided into two groups. The first, control group consisted of 5 sectional cases of a morphologically normal colon wall. The second group was represented by the surgical material of 10 patients with subcompensated dolichocolon. Observation groups were representative by sex and age.Results. In patients with subcompensated dolichocolon, compared with the control group, the thickness of the mucosa in the colon wall is statistically significantly (p=0.034) reduced by 1.06 times, which indicates atrophy; the thickness of the submucosal layer increases by 1.55 times due to edema with foci of sclerosis (p=0.0001); the thickness of the muscle layer increases by 1.16 times (p=0,0003), because of working hypertrophy and compensatory hyperplasia of smooth muscle cells; at the same time, the number of nerve cells in Auerbach's plexuses decreases by 1.59 times (p=0,0001), which will lead to atrophy of the muscle layer and decrease its evacuator-motor function; the average area of lymphoid follicles increases by 1.35 times (p=0,003) and the percentage of secondary follicles decreases 8 times (p=0,0001), which is a consequence of congestion of intestinal contents and activation of the intestinal lymphoid apparatus.Conclusion. Morphological signs of atrophy and sclerosis changes of the cellular elements of the colon neuromuscular apparatus begin to form at the subcompensated stage of dolichocolon, which requires new objective clinical and morphological indications for surgical treatment of patients in order to prevent the development of decompensation of the patients’ general condition and severe complications.
The article provides a brief overview of the frequency and prevalence of Pair syndrome, the causes of its development, the clinical picture and diagnosis of this form of splanchnoptosis, the tactics of surgical treatment depending on the stage of the disease. There are 2 clinical cases of successful surgical treatment of chronic constipation in patients with Pair syndrome. At the same time, in the classical picture of the disease, left-sided hemicolectomy with a thick-colonic anastomosis "end to end" was performed, in a patient with concomitant diverticular disease - an extended hemicolectomy. All patients are discharged with recovery, all have an independent regular stool every 1-3 days
Constipation is a serious medical and social problem due to the widespread prevalence of this condition, a decrease in the quality of life and social activity of patients. For the successful treatment of constipation, it is necessary to establish the causes leading to the violation of the stool in the patient. And this task is a priority for the doctor at the outpatient stage.The clinical features of constipation largely depend on their cause, duration, severity and characteristics of intestinal damage. Constipation is often accompanied by general somatic and other gastroenterological symptoms.Within the framework of the review article, the main conditions and diseases are considered, in the clinical picture of which there is constipation syndrome, which must be considered by the doctor at the outpatient stage when conducting differential diagnosis and prescribing appropriate treatment, which also presupposes impact on causal factors. Currently, drugs based on high molecular weight polyethylene glycol 4000 are widely used to treat chronic constipation in adults and children in most countries of the world. Preparations based on polyethylene glycol 4000 are affordable and easy to use, they can be used both on an outpatient basis and in a hospital. Polyethylene glycol 4000 preparations act quickly, are highly effective and well tolerated, have a high safety profile (practically does not affect homeostasis) both for adult patients and in pediatric practice. International clinical trials have shown the possibility of long-term use of polyethylene glycol 4000 preparations.Current international clinical guidelines and domestic clinical guidelines for the treatment of constipation recommend the use of polyethylene glycol 4000 preparations instead of lactulose and volume-forming laxatives in the symptomatic treatment of constipation in children and adults. In the second part of the review, the possibilities of polyethylene glycol 4000 and the first domestic drug polyethylene glycol 4000 in the treatment of chronic constipation are considered.
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