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FEATURES OF THE CLINICAL COURSE OF VISCEROPTOSIS IN
COMBINATION WITH CHRONIC COLOSTASIS
Khusanov S.M.
Botirov A.K.
Mamajonova D.M.
Botirov J.A.
Andijan State Medical Institute, Uzbekistan
https://doi.org/10.5281/zenodo.15128596
Relevance of the Problem.
Visceroptosis has several synonyms
(enteroptosis, splanchnoptosis, Glenard syndrome; from Greek σπλάγχνα –
internal organs and πτῶσις – prolapse) [2;4]. According to various researchers,
visceroptosis is complicated by chronic colostasis in 30-40% of cases and is one
of the common diseases among the working-age population [3]. The prevalence
rate is unknown, as the disease presents clinical symptoms in only 10-20% of
cases [1].
The aim of the study.
To determine the clinical course characteristics of
visceroptosis in combination with chronic colostasis.
Materials and Methods.
This study was conducted on 132 patients
diagnosed with visceroptosis in combination with chronic colostasis (CC), who
underwent inpatient treatment at the coloproctology department of the Surgery
and Civil Defense Department of the Andijan State Medical Institute Clinic.
Inclusion Criteria:
1. age over 18 years; 2. verified diagnosis of
visceroptosis in combination with colostasis (CC); 3. elective nature of the
pathology; 4. absence of acute infectious and inflammatory diseases; 5. written
consent from the patient and their relatives for examination and treatment.
According to the study’s aim and objectives, the patients were conditionally
divided into two groups:
comparison group
(2018–2022) – 85 patients (64.4%) who underwent a
retrospective analysis of surgical treatment outcomes following traditional
approaches.
main group
(2020–2023) – 47 patients (35.6%) who underwent a
prospective study of surgical treatment with an optimized surgical strategy.
To achieve the research objectives, clinical-laboratory, instrumental, and
statistical studies were conducted in accordance with the latest standard
methodologies recommended by the Ministry of Health of the Republic of
Uzbekistan.
Results and Discussion:
The uniformity of the primary surgical pathology,
equal conditions for providing specialized care, the similarity of comorbidities
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and their frequency, as well as the nature of surgical interventions, allowed us to
present the quantitative characteristics in a consolidated form.
An analysis of the gender distribution of patients with visceroptosis
combined with chronic colostasis (CC) in elective surgery conditions showed
that men accounted for 28 cases (23.3%), while women made up 104 cases
(78.8%). Our analysis indicates that visceroptosis combined with chronic CC is
predominantly diagnosed in female patients, with an average ratio of 3.7:1. This
finding warranted a more detailed investigation of this pattern. Visceroptosis
combined with chronic colostasis (CC) was most frequently diagnosed in
patients aged 45–59 years—67 cases (50.8%). This age group represents the
most active working population, which is often exposed to external factors.
Among patients aged 18–44 years, visceroptosis with chronic CC was diagnosed
in 37 cases (28.0%), mostly associated with congenital developmental
anomalies. Patients aged 60 years and older accounted for 28 cases (21.2%),
suggesting excessively prolonged conservative treatment. Surgical intervention
for visceroptosis with chronic CC was performed in patients with a disease
duration of 1–5 years in 42 cases (31.8%), including 37 women (28.9%) and 5
men (3.8%). The disease duration of 6–10 years was observed in 64 patients
(48.5%), comprising 47 women (35.6%) and 17 men (12.9%). Particular
concern arises for patients with a disease duration of over 10 years—26 cases
(19.7%), including 20 women (15.2%) and 6 men (4.5%).
To determine the factors contributing to visceroptosis, we analyzed the
div constitution of the studied patients. It is noteworthy that visceroptosis was
most frequently diagnosed in patients with an asthenic div type—84 cases
(63.6%), including 16 men (12.1%) and 68 women (51.5%). Among patients
with a normosthenic div type, the disease was identified in 43 cases (32.6%),
with 8 men (6.1%) and 35 women (26.5%). The condition was diagnosed least
frequently in patients with a hypersthenic div type—only 5 cases (3.8%),
including 4 men (3.0%) and 1 woman (0.8%).
The clinical symptom complex of visceroptosis combined with chronic
colostasis (CC) consisted of general and local symptoms. Constipation, as the
main manifestation of visceroptosis, was observed in 110 patients (83.3%),
while alternating constipation and diarrhea occurred in 22 patients (16.7%). A
feeling of heaviness in the abdomen was noted in 102 cases (77.3%), intestinal
bloating in 89 cases (67.4%), and pain of varying intensity in 127 cases (96.2%).
Abdominal sagging and striae were found in 25 patients (18.9%), diastasis of the
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anterior abdominal wall muscles in 9 cases (6.8%), and intoxication symptoms
(weakness, dizziness, nervousness) in 129 cases (97.7%).
In visceroptosis combined with chronic CC, an analysis of the degree of
colonic obstruction was conducted, as unreasonably prolonged conservative
treatment worsens patients' conditions, negatively affecting their quality of life.
The compensated stage of visceroptosis (constipation lasting less than 3–4 days)
was observed in 26 cases (19.7%). The subcompensated stage (constipation
lasting 5–10 days) was identified in 61 cases (46.2%), while the decompensated
stage (constipation lasting more than 10 days) was detected in 45 cases
(34.1%).
Determining the degree of colonic obstruction in visceroptosis was
essential for establishing the scope and timing of surgical intervention.
As is well known, comorbid therapeutic conditions significantly influence
the choice of surgical tactics and postoperative rehabilitation. Among the
studied patients, cardiovascular diseases (ischemic heart disease, hypertension,
angina pectoris) were the most frequently diagnosed, occurring in 25 cases
(18.9%). Diseases of the hepatobiliary system (type 2 diabetes mellitus, chronic
cholecystitis) were identified in 10 cases (7.6%), chronic obstructive pulmonary
diseases (chronic bronchitis, pneumonia, bronchial asthma) in 8 cases (6.1%),
and genitourinary system diseases (chronic pyelonephritis, cystitis) in 11 cases
(8.3%).
Severe comorbid therapeutic conditions created additional challenges in
determining surgical tactics and postoperative rehabilitation, especially given
the initially severe condition of the patients. A history of previous surgical
interventions was noted in 58 cases (43.9%) among patients with visceroptosis
combined with chronic colostasis (CC). Of particular note was the relatively high
frequency of cesarean sections—25 cases (18.9%)—as well as surgical
interventions for large ventral hernias and diastasis of the anterior abdominal
wall muscles in 13 cases (9.8%).
The conducted analysis suggests that multiple pregnancies (cesarean
sections) and the presence of large ventral hernias with muscle diastasis play a
role in the development and progression of visceroptosis. Additionally, a history
of cholecystectomy was recorded in 5 cases (3.8%), appendectomy in 8 cases
(6.1%), and hysterectomy with extirpation in 7 cases (5.3%).
Conclusion.
The study identified the clinical features of visceroptosis,
which include a significant predominance of females, with a male-to-female ratio
of 3.7:1, and a high incidence in middle age. Diagnosis at a young age indicates
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congenital developmental anomalies, while diagnosis in older patients suggests
excessively prolonged conservative treatment, leading to disease progression.
The clinical symptom complex consisted of general and local symptoms, with the
main manifestations being constipation, alternating constipation and diarrhea,
as well as dyspeptic symptoms and signs of intoxication. Comorbid therapeutic
conditions were observed in 40.1% of cases, with cardiovascular diseases
accounting for the majority (18.9%). The analysis suggests that multiple
pregnancies (cesarean section—18.9%) and the presence of large ventral
hernias with muscle diastasis (9.8%) play a role in the development and
progression of visceroptosis.
Thus, in cases of visceroptosis combined with chronic colostasis,
considering the clinical course features will allow for the optimization of
surgical tactics and improved treatment outcomes.
References:
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Bokovoy S.P. Symptomatology and Diagnosis of Right-Sided Visceroptosis
// Urological Gazette. -2017. Vol. 7. No. 2. P. 16-24.
2.
Visceroptosis - Causes, Symptoms, Diagnosis, and Treatment.
https://www.krasotaimedicina.ru/diseases/zabolevanija_gastroenterologia/vis
ceroptosis, 2024.
3.
Tobokhov A.V., Nikolaev V.N. Condition of Digestive Organs in Patients
with Visceroptosis Complicated by Chronic Colonic Stasis Syndrome // Bulletin
of the North-Eastern Federal University. -2015. -No. 1 (1). Accessed: 25.09.2024.
4.
Bergmann M., Lipsky H. Die Nephropexie mit Faszienstreifen. Z Nephrol. -
1969;62;739-750.
