Dolichosigma
The content of the article:
- Causes and risk factors
- Forms of the disease
- Disease stages
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Dolichosigma is a pathological lengthening of the sigmoid colon (that is, part of the colon of the large intestine) and its mesentery without changing the muscle layer.
Normally, the sigmoid colon is located in the left ileum; its length varies widely - from 20 to 86 cm, averaging 45 ± 14.5 cm. If the length of the intestine exceeds the upper limit of the norm, they speak of dolichosigma. With this pathology, the intestine, which normally has an S-shaped structure, acquires 2-3 additional loops.
Dolichosigma is a pathological lengthening of the sigmoid colon
The frequency of occurrence of dolichosigma reaches 15–20%, although the reliable incidence is unknown due to low diagnosis (due to nonspecific manifestations of the disease, patients often do not seek medical help, preferring self-medication).
Disputes about the pathology of this condition have been going on for many years, due to the specifics of the painful symptoms. Most patients with dolichosigma present active complaints, they have an objective picture of the painful condition, while about 15% of carriers of the disease do not notice any disturbances in the functioning of the gastrointestinal tract and often find out about its presence during examination for other diseases.
In patients with dolichosigma, as a rule, pathological changes are found not only of a physiological, but also of a morphological nature: sclerotic processes in the wall of the organ and its mesentery, damage to the nerve nodes, thinning and dystrophy of the mucous membrane, hypertrophy of the muscle layer.
Causes and risk factors
The main cause of dolichosigma is called a congenital malformation of the colon, despite the fact that the disease often debuts in patients after 40-50 years.
The main causal factor in the formation of an anomaly is the effect of aggressive agents on the fetus in the prenatal period, in the process of development of the digestive tract:
- infectious diseases of a viral or bacterial nature, transferred by the mother during pregnancy (especially in the 1st trimester);
- taking medications with a teratogenic effect, prohibited substances;
- unfavorable ecological environment;
- the impact of industrial hazards;
- alcohol abuse, smoking during pregnancy;
- the use of foods containing a large amount of synthetic chemical compounds (preservatives, stabilizers, unnatural colors and flavors).
A number of researchers indicate the possibility of inheriting this pathology in an autosomal dominant or autosomal recessive manner, which is associated with the rather frequent detection of dolichosigma in close relatives.
Forms of the disease
In accordance with the clinical picture, the disease is divided into the following forms:
- without clinical manifestations (asymptomatic dolichosigma);
- with impaired transit through the colon;
- complicated dolichosigma.
Dolicosigma occurs in 15-20% of the world's population
Disease stages
Depending on the severity of painful symptoms, 3 stages (stages) of the disease are conventionally distinguished, the duration of which is purely individual:
- Compensation stage - painful manifestations are neutralized by the tension of the body's compensatory capabilities.
- Subcompensation stage - depletion of compensatory resources, increased symptoms.
- The stage of decompensation is a breakdown of the adaptive potential, a vivid clinical picture, deterioration not only in the functioning of the gastrointestinal tract, but also in general well-being.
It is thanks to the powerful compensatory capabilities that the disease often demonstrates a detailed clinical picture at a fairly mature age, and in some cases, the manifestations of dolichosigma may be absent throughout life.
Symptoms
The main symptoms that make it possible to suspect lengthening of the sigmoid colon are:
- constipation, which is of a regular, systematic nature (prolonged straining, hard lumpy feces, a feeling of incomplete emptying of the intestines, a feeling of obstruction in the anorectal region) - more than 12 weeks during the year;
- recurrent flatulence;
- pain in the abdomen.
Constipation is the leading clinical sign of dolichocolon. If the stool retention does not exceed 2-3 days, there are usually no other complaints. The patient may experience minor discomfort in the left iliac region and lower abdomen, although usually such constipation is not accompanied by additional symptoms and does not affect the quality of life. Longer constipation is characterized by severe abdominal discomfort and pain, bloating, and sometimes complications. At the stage of subcompensation, constipation can last 7 or more days.
The main sign of dolicosigma is constipation
Pain in the abdomen is localized in the left iliac region, is of an intense paroxysmal nature, and disappears after the act of defecation. When pressed in the projection of the intestine, there is a sharp soreness.
Diagnostics
Diagnosis of dolichosigma is based on a comprehensive assessment of subjective and objective research data:
- collection of information about previous symptoms (stool retention, episodes of paroxysmal pain, flatulence);
- physical examination - abdominal distension of varying severity, tenderness on palpation in the left iliac and umbilical regions, in the lower abdomen, percussion - tympanic sound;
- irrigoscopy with double contrast (air and barium suspension) - assessment of the size, shape and location of organs in the abdominal cavity;
- control of the passage of barium along the alimentary canal - revealing the fact of a delay in the movement of contents through the intestine and assessing its degree;
- colonoscopy - assessment of the anatomical and physiological state of the colon;
- Ultrasound examination of the abdominal and pelvic organs.
Treatment
Treatment tactics are determined depending on the presence or absence of complications.
Therapy for uncomplicated dolichosigma:
- adherence to a corrective diet (a large amount of dietary fiber in the diet, water-salt regime);
- an adequate regimen of physical activity;
- physiotherapeutic methods of influence (electrical stimulation, reflexology);
- drug treatment (drugs that increase the volume of feces, saline laxatives, prokinetics, as needed - pro and prebiotics, defoamers, antispasmodics, sedatives, hypnotics).
Surgical treatment of dolicosigma is indicated in the presence of complications
Treatment of complicated dolichosigma (or uncomplicated, but not amenable to conservative treatment, critically affecting the social and work activity of the patient) involves bowel resection.
Endoscopic detorsion is the treatment of choice for sigmoid volvulus.
Possible complications and consequences
The main complications of dolichocolon:
- volvulus;
- intussusception;
- the formation of fecal stones;
- nodulation.
The above pathological conditions can lead to the development of intestinal obstruction.
Forecast
With timely treatment started, the prognosis is favorable. It worsens with prolonged, intense constipation that does not respond well to conservative treatment. Surgical treatment of constipation has ambiguous functional results and is accompanied by a relatively high risk of complications: on average, 20% (2–71%), with a mortality rate of 2.6% (0–15%).
Prevention
Since the disease is congenital, there is no effective primary prevention in this case.
Secondary prevention measures:
- compliance with the drinking regime;
- a balanced diet high in dietary fiber and fiber;
- physical activity;
- refusal to suppress the urge to defecate, allocating sufficient time to visit the toilet.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
