THE CHRONIC CONSTIPATION IN CHILDREN
Dec 18th 2017Sergey MinaevFor scientists & Pediatrics & Surgery
The chronic constipation in childhood, in spite of the modern development of coloproctology, remains serious and in many aspects an unresolved problem. Therefore the choice of volume of an optimum level of resection is of great importance in depression of quantity of relapses after the surgical treatment. The differentiated approach applied now to surgical treatment in constipation is based on radiological data (a choice of the area with the most expressed stasis) and consists in resection of the zone of the faulty innervation of colon with excision of the decompensated organ parts.
Interconnection of correlations of the acid-base blood balance with dysbiosis in 121 children with chronic constipation was found in the study [1]. Metabolic acidosis is revealed with a high lactate concentration, emaciation of the organism buffer systems on the lowering background of main blood electrolytes and dehydration. And in its turn it takes place on the marked translocation of the intestinal microflora. The largest changes in the acid-base balance can be considered as a factor of the critical conditions in case of decompensated form of chronic constipation in this group of patients. The exposed changes must be taken into account not only while carrying out the intensive therapy of the occurred complications, but in case of conducting of conservative methods of correction of the disease. The lactate level in the blood can serve as a criterion of the efficiency of the operation in children with chronic constipation. Also it can be testify to the development of critical conditions.
In the study [2] was to determine the ability of the research method of vector quantity in different variants of chronic constipation in children. The work is based on the observation of 722 children aged from 10 days to 18 years with chronic constipation: 280 patients had Hirschsprung’s disease, 320 – dolihokolon and 122 – functional constipation. All children at admission and after treatment underwent a comprehensive survey, which included, inter alia, the study of a vector volume of the rectum finite division. All of the surveyed patients revealed vector volume images characteristic for different types of chronic constipation. Therefore, the study of a vector volume in the colon can be used to monitor the effectiveness of treatment for chronic constipation in children, as an accurate and descriptive research method in child proctology.
Investigation the ultrasonic way of the intraoperative assess of the resection volume of colon in children with chronic constipation was carried out [3]. Research of 30 histological specimen of colon (autopsy material of normal colon wall) allows differentiating 5 layers in its wall. At intraoperative ultrasonic research of a colon wall in patients with chronic constipation, specific changes like hyperechoic inclusions in a wall structures are taped, that allows to define a degree of the specified changes and thereby resection level. Bench ultrasonic researches of various departments and colon sites, carried out on 30 histological specimens of colon, consisted of autopsy material gives rather detailed picture of the wall structure of an organ. The most important characteristics of the examined parts are the thickness of every layer and its echogenicity. During operations in 11 patients with decompensated forms of the chronic constipation, we managed to carry out an intraoperative ultrasonic diagnostics of the colon wall that was very important for differentiation of the changed parts of the organ, which required resection. With ultrasonic examination of the changed structure of the organ, special attention should be paid to the authentic increasing of the thickness of muscular layer of colon wall in a proximal way and decreasing of the submucous and subserous membranes thickness.
In the article Polukhov R. [4] presented the results of the conservative treatment of chronic constipation in 574 children divided into groups: group I (321 patients) – traditional treatment, group II (248 patients) – traditional approach complemented with optimal treatment of dysbiotic disorder by Magnerot and Glutathione. The results has been assessed in 1, 2 and 3 years and appeared to be considerably better in group II. Good results in children of this group were achieved by the end of the first year of the proposed complex treatment, whereas in the cases of the traditional approach a stable effect was obtained in no less than 3 years.
References:
- Kirgizov I. V., Minaev S. V., Kachanov A. V. The interconnection acid-base blood balance and dysbiosis in children with chronic constipation. Medical News of North Caucasus. 2017;12(3):273-276. https://doi.org/10.14300/mnnc.2017.12075
- Svarich V., Kirgizov I.V., Abayhanov R. Vector volume in different variants of chronic constipation in children. Medical News of North Caucasus. 2014;9(1):32-34. https://doi.org/10.14300/mnnc.2014.09909
- Kirgizov I. V., Minaev S. V. The ultrasonic way of the intraoperative assess of the resection volume of colon in children with chronic constipation. Medical News of North Caucasus. 2014;9(2):125-128. https://doi.org/10.14300/mnnc.2014.09035
- Polukhov R. Sh. Efficacy of the complex conservative treatment of chronic constipation in children. Medical News of North Caucasus. 2016;11(4):580-582. http://doi.org/10.14300/mnnc.2016.11139
