CLINICAL AND RADIOLOGICAL CHARACTERISTICS OF COLOSTASIS IN CHILDREN

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ABSTRACT

At the present stage of development, one of the most common pathological conditions of the gastrointestinal tract

(GIT) in children is chronic constipation. Chronic constipation is a serious medical and social problem in all countries of

the world, due to its wide prevalence, low effectiveness of therapy, reduced social activity, impaired quality of life of

patients and increased use of healthcare resources.

KEYWORDS

Colostasis, independent stool, chronic constipationin children.

INTRODUCTION

According to modern literature, from 10 to 40% of

children in the population suffer from constipation.

However, it is impossible to establish the true

frequency of constipation in childhood, because due to

the low level of medical culture of a part of the

population and the lack of sanitary propaganda, the

number of doctors consulting about this remains low

[2,19,22,24,26]. In most cases, the first complaints of

constipation appear at the age of 2

–

4 years, but the

pathological complex itself begins to form much

earlier. Very often, not considering constipation in a

child as a disease, parents independently use enemas,

laxatives and go to the doctor already with the

Research Article

CLINICAL AND RADIOLOGICAL CHARACTERISTICS OF COLOSTASIS IN
CHILDREN

Submission Date:

May 20, 2023,

Accepted Date:

May 25, 2023,

Published Date:

May 30, 2023

Crossref doi:

https://doi.org/10.37547/ajbspi/Volume03Issue05-07

Raupov F.S.

Bukhara State Medical Institute, Bukhara, Uzbekistan

Journal

Website:

https://theusajournals.
com/index.php/ajbspi

Copyright:

Original

content from this work
may be used under the
terms of the creative
commons

attributes

4.0 licence.

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development of certain complications of the disease

[1,12,18,21,23,25].

Despite the fact that in 95% of cases chronic

constipation is initially functional in nature and can be

stopped by non-drug methods, late seeking medical

help, the patient's unwillingness to change the nature

of nutrition and physical activity, low patient

confidence in therapy lead to decompensation and the

formation of organic pathology of the colon. intestines

[3,7,14,21,27,28]. Long-term retention of contents in

the intestine adversely affects the development of the

child, contributes to the occurrence of various

complications and diseases of the colon [4,9,15,20].

According to some authors, 35% of girls and 55% of boys

aged 6 to 12 suffering from constipation develop anal

incontinence (encopresis), which can lead to their

social exclusion. According to the clinical observations

of some authors, very often a misunderstanding of the

concept of "constipation" only as "rare defecation"

leads to late seeking medical help already at the stage

of decompensation with the development of

complications [5,11,16,17]. Full intestinal peristalsis is

the result of the functioning of the enteric nervous

system, muscles and connective tissue. Malfunction of

any of these components leads to a violation of

peristalsis, which can cause constipation in children

[8,10,17,29].

When analyzing the literature data, there is quite a lot

of material on the problems of constipation in children,

but they do not have a systematic, complete review

and analysis. To this day, there are no clear indications

for surgical treatment of colostasis, the timing of the

operation, the problem of determining clear

indications and contraindications for the operation has

not been resolved. Surgeons in carrying out

interventions are based on their own experience and

knowledge gleaned from well-known literary sources.

That is why, there are still a large number of intra- and

postoperative complications, there are no standards

for the care of patients before and after surgical

interventions.[6,15,17].There are no diagnostic, clinical

criteria for colostasis in the age aspect in children,

which determine the relevance of conducting in-depth

experimental and clinical studies in this direction.

Purpose of the study. The study of the features of the

clinical and radiological picture of chronic colostasis in

children.

Materials and research methods.INThe basis of this

work included data from the examination and

treatment of 149 sick children aged from 1 month to 14

years with colostasis. The analysis of patients who

received treatment in the Department of Pediatric

Surgery of the Bukhara Regional Children's

Multidisciplinary Medical Center for the period 2020-

2023 was carried out. The main criterion for inclusion of

patients in our study was the presence of colostasis,

patients' complaints about the lack of independent

stool. The work does not include patients with the total

form of Hirschsprung's disease.

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All children underwent a comprehensive examination

used in pediatric surgery, including clinical and

laboratory, x-ray studies: detailed study and history

taking, clinical objective examination, if necessary,

rectal digital examination; general clinical tests - a

general analysis of blood, feces and urine; X-ray

contrast study - irrigography of the colon with a

solution of barium sulfate according to the method of

A.I. Lenyushkin.

Discussion of results.According to our data, of the

currently existing research methods, polypositional

irrigography is the most accessible, valuable and

reliable for optimizing the diagnosis of colostasis in

children. When it was used at the time of batch filling

of the contrast, all sections of the large intestine were

filled with contrast and a series of images were taken

in different positions (position) of the patient: lying on

his back, standing, on the right and left side, and after

emptying the contrast.

This allows you to determine the physiological state,

the presence of additional bends, elongation,

incomplete fixation, rotation and rigidity of the colon,

which allows you to determine the degree of violation

of transient function.

Dolihosigma according to A.I. Lenyushkin is diagnosed

in 15% of healthy children, taking into account the

elongated multi-loop or two-loop sigmoid colon, when

the loops are located in the abdominal cavity, reaching

the splenic or hepatic flexure of the colon. In this case,

the intestine is excessively mobile, freely moves in the

abdominal cavity, additional loops remain after bowel

emptying.

A common cause of sub- and decompensated forms of

colostasis in children is the rare appeal of the parents

of a sick child to a specialist at an early stage of the

disease, the lack of awareness of general practitioners,

pediatricians,

gastroenterologists

and

pediatric

surgeons in primary and secondary health care about

early diagnosis and treatment of the disease.

Sometimes, as a result of prolonged and excessive

drug treatment of patients with an incorrect diagnosis,

without

x-ray

examination

and

pathogenetic

justification,

by

a

general

practitioner

or

gastroenterologists, the patient receives symptomatic

and unreasonable treatment. On the other hand,

pediatric surgeons, leaning toward the diagnosis of

Hirschsprung's disease, resort to surgical treatment,

which cannot be considered pathogenetically

substantiated.

Therefore, in our opinion, it is reasonable to conduct an

X-ray contrast study with a solution of barium sulfate -

irrigography of the colon in sick children suffering from

constipation. Irrigography is a mandatory study in all

children with suspected constipation. The sensitivity

and specificity of the method, according to some

literature data, reaches up to 90%, respectively. The

timing of the X-ray examination depends on several

factors, the main of which is the efficiency of emptying

the colon. It is advisable to perform the examination

not immediately after the patient's admission to the

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hospital, but delayed, after stopping the effects of

fecal intoxication.

In order to study the anatomical and physiological

state of the colon, radiopaque irrigography is

performed, which makes it possible to assess the

evacuation function of the colon and the presence of

its structural changes. By the nature of the evacuation

of the contrast agent, the contour of the intestine, the

state of the haustra (increased or smoothed) and the

presence of spasm (local or total), one can speak of a

hypotonic, atonic or spastic condition of the colon.

This

well-studied

and

long-used

method

of

examination makes it possible to establish the correct

diagnosis in most cases. However, the known

radiological criteria do not always allow to do this

accurately enough in the group of children with chronic

colostasis,

where

dolichocolon,

functional

constipation, Hirschsprung's disease are most

common.

Dolichocolon has specific features in the form of

additional loops of the large intestine, often extending

beyond its anatomical zone. The diagnosis of

functional constipation is established in the presence

of a uniform expansion of the distal colon, with the

exclusion of other causes that cause colostasis.

For long forms of Hirschsprung's disease, the most

characteristic is the presence of a narrowed

aganglionic zone, suprastenotic expansion and a

funnel-shaped transition zone. At the same time, the

reliability of X-ray examination is 80%, and in

Hirschsprung's disease with a supershort segment, it

exceeds 20%. To assess the condition of the mucous

membrane of the colon, an endoscopic examination

(rectoscopy, colonoscopy) with targeted biopsy for

histological and, if necessary, histochemical analysis is

indicated. They allow you to identify acute and chronic

inflammatory diseases of the colon, determine the

stage of the disease, and evaluate the effectiveness of

treatment.

Histochemical study of cholinesterase activity is

necessary

in

the

differential

diagnosis

of

Hirschsprung's disease from functional megacolon, in

which this reaction is negative.

Currently, in the literature there are such terms as

"dolichosigma", "megadolichosigma", "megasigma",

"dolichocolon", etc., which are used to refer to

supposedly independent nosological forms, which only

creates confusion in the terminology and assessment

of the lesion. Dynamic observation with X-ray control

allows in some cases to note the appearance of

dilatation of the lumen of the sigmoid colon, which was

not previously observed in this patient. There is a

certain relationship between an increase in the lumen

of the sigmoid colon and the duration of persistent

constipation. This suggests that the occurrence of

dilatation is not a new form of the disease, but

represents the progression of dysfunction of the

sigmoid colon in dolichosigmoid.

The patient's irrigogram shows (Fig. 1) a two-loop

dolichocolon

with

dilatation

of

the

colon,

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transversoptosis with a bend of the splenic angle.

Figure 2 shows colonic expansion with dilatation

throughout, a “multi

-

loop” kink that forms acute

angles, and radiographic evidence of transversoptosis

with a 180-degree kink in the splenic angulation.

Fig.1. Dolichocolon, "two-loop" with dilation

Fig.2. Dolichocolon, "multi-loop" with

dilation

The following figures (Fig. 3 and 4) show a single-loop

dolichocolon

with

dilatation

of

the

colon,

transversoptosis with a bend in the splenic angle. The

drawings show the expansion of the colon with

dilatation along its entire length, a “one

-

loop” bend

that forms acute angles, and there are also radiological

signs of transversoptosis with a bend in the splenic

angle by 180 degrees.

Fig.3. Dolichocolon, "one-loop" with
dilatation, bending of the splenic
angle

Fig.4. Dolichocolon, "single-

loop" with dilatation bending

of the splenic angle

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These radiographic criteria in patients with sub- and compensatory courses of dolichosigmoid were evaluated in a

point system, which is important for optimizing indications for surgical treatment (Table No. 1).

Criteria for evaluating polypositional irrigography to optimize indications for surgical treatment of colostasis in

children

Table 1

Curvature of the colon

Condition of the corners of the colon (in degrees) and

scores (in points)

with irrigography

Normal angles (75°

<)

(1 point)

sharp corners

(25-75°)

(2 points)

Too sharp corners

(25°>) (3 points)

anorectal

20

2

3

Recto-sigmoid

1

2

3

Sigmoid-decendal

1

2

3

Splenic

1

2

3

Hepatic

1

2

3

Additional loops

1

2

3 or more

Points

6

12

18 and over

When interpreting the data obtained, we took into

account the sum of points scored during polypositional

irrigography, as well as during the collection of

anamnesis and objective clinical examination, as well

as on the basis of general clinical, laboratory, rectal

examinations.

Those patients with a total score of more than 6 points

underwent complex conservative treatment. If the

total score was over 12, we performed multiple (3 or

more times) complex conservative treatment, and if it

was ineffective, we determined the relative indications

for surgical treatment. The total score was over 18, not

only the pathology of the colon was often detected,

but also other defects in the form of a violation of the

fixation of the pelvic floor muscles with clinical

complete disorders of the motor-evacuation function

of the colon, was determined as a direct indication for

surgical treatment. At the same time, many issues of

conservative treatment in 149 sick children who came

to us with different genesis of colostasis, issues of

conservative treatment were resolved jointly with a

gastroenterologist,

nutritionist,

endocrinologist,

neuropathologist.

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Based on the above data, we have developed an

approximate management scheme (algorithm) for sick

children with colostasis. Of the 149 patients examined,

131 (88.0%) patients were treated conservatively, the

remaining 18 (12.0%) patients were treated surgically. In

the long-term period of treatment, the condition of the

patients is satisfactory, no complication was observed.

CONCLUSION

Thus, the assessment of the clinical and radiological

characteristics of patients with constipation in children

makes it possible to determine the indications for

conservative and surgical treatment tactics. The

conditions for the effectiveness of the prevention and

treatment of constipation, improving the quality of life

of sick children is the interaction of the doctor and the

patient in choosing the timing of surgical correction,

suitable for each individual child with organic

constipation, as well as the optimal management

tactics for functional constipation.

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