Volume 03 Issue 05-2023
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2771-2265)
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03
ISSUE
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(2023:
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OCLC
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1121105677
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ABSTRACT
One of the most common pathological conditions of the gastrointestinal tract (GIT) in children is constipation.
Constipation in children is a serious medical and social problem in all countries of the world, primarily 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
Constipation, colostasis, independent stool.
INTRODUCTION
Etiopathogenetically, in violation of the evacuation
function of the large intestine, constipation develops
(constipation, obstipacio - accumulation) - a condition
that is manifested by an increase in the intervals
between bowel movements (compared to the
individual norm) or systematic insufficient emptying of
the intestines [1,4,17]. As a result, the quality of life of
sick children deteriorates, which negatively affects the
growth and development of the child's div. Lack of
timely correction and treatment of constipation leads
to various complications, including organic ones
[2,4,16,22,23].
The criterion for chronic constipation in children is a
persistent decrease in the defecation rhythm that lasts
more than 3 months. In addition, constipation is
considered those cases when a child has painful
defecation with feces that are dense in consistency
Research Article
CLINICAL CHARACTERISTICS OF CHRONIC COLSTASIS IN CHILDREN
Submission Date:
May 20, 2023,
Accepted Date:
May 25, 2023,
Published Date:
May 30, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue05-11
Nuriddinov S.S.
Bukhara State Medical Institute, Bukhara, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 05-2023
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Publisher:
Oscar Publishing Services
Servi
with a stool frequency corresponding to the age norm
[3,6,14,21,26,28]. It should be noted that with daily
defecation, the presence of straining, a feeling of
incomplete emptying, changes in the nature of the
stool (“sheep feces”, a large diameter of the fecal
cylinder)
also
indicates
chronic
constipation
[1,4,15,20,24,25,27,29].
Currently, there are several classifications of
constipation in children. In pediatric surgery, the
classification of A.I. Lenyushkin is most often used.
[8,13], which more fully takes into account the
etiopathogenetic features of constipation in children.
According to A.I. Lenyushkin distinguish 3 stages of
constipation: compensated, subcompensated and
decompensated, requiring appropriate treatment
tactics [4,9,18].
With a compensated stage of constipation, the
frequency of stool is 1 time in 2-3 days, the patient
complains of a feeling of incomplete emptying of the
intestine, flatulence, abdominal pain, which increases
or disappears after defecation. [4,12,17].
The subcompensated stage is characterized by stool
retention from 3 to 5 days or its absence. As a rule,
defecation occurs after taking a laxative or cleansing
enemas. The patient is often worried about abdominal
pain, flatulence, painful defecation, extraintestinal
manifestations of constipation appear [1,4,12].
At the decompensated stage of constipation, there is a
long stool retention (up to 10 days or more), the
absence of an independent stool is noted when the
stool is observed only after siphon or hypertonic
enemas. When examining a patient, symptoms of
endogenous intoxication are expressed, fecal stones
are palpated along the intestine, encopresis appears,
the development of chronic pathology of the overlying
organs of the gastrointestinal tract is characteristic
[8,10].
According to some authors, in pediatric surgery and
pediatric practice, a classification that divides
constipation into organic and functional is convenient
[4,8]. If an organic cause of constipation is suspected
(Hirschsprung's disease, dolichosigma, etc.), it is
necessary to conduct special examinations of the child
as early as possible to determine the rational tactics of
his treatment - therapeutic or surgical. Constipation
due to organic causes is a symptom of the underlying
disease. In the event that an organic lesion of the
intestine is excluded during the examination, they
speak of functional constipation. In children,
constipation is usually functional in nature [7,9].
Purpose of the study. The study of some features of
the clinical course of colostasis in children in the age
aspect.
Materials and research methods. The basis of this work
included data from the examination and treatment of
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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.
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. Conducted sphincteromanometry to
determine the tone of the sphincter in some patients.
Discussion of results. When analyzing the data, the
distribution of patients with colostasis depending on
gender and age was dominated by boys - 82 (55.0%),
compared with girls - 67 (45.0%). When distributing
patients by age categories, at the age of 1 to 4 years,
accounting for 34 (22.8%) in boys and 31 (20.8%) in girls,
in the age group from 5 to 9 years, boys accounted for
20 (13.4%), girls of this age accounted for 12 (8.0%) of
the examined patients, sick male children were
predominant (Table 1). In our opinion, functional
constipation affects the quality of life of patients from
the age of one year and is the reason for hospitalization
in a hospital to determine the etiology of constipation.
Distribution of patients with colostasis depending on gender and age
Table 1.
Floor
Age of patients
(WHO classification 2021)
0-27
days
01
–
11
month
01-4
years
5
–
9
years
10-14
years
Total:
n, %
boys
*
24
16.1%
34
22.8%
20
13.4%
4
2.7%
82
(55%)
girls
*
21
14.1%
31
20.8%
12
8.0%
3
2.1%
67
(45%)
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5.
893
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6.
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)
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Publisher:
Oscar Publishing Services
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Note: *- children of the early postnatal period of development are not included in our study.
The smallest number of patients was at the age of 10-
14 years - 7 (4.8%), which is associated with low parents
seeking medical help and acquiring skills to control
stool frequency, as well as relative adaptation to the
pathological condition in children of senior school age.
In almost all studies, constipated children showed a
higher prevalence of constipation in boys than in girls.
This may not be the result of a true difference in
frequency, but due to a difference in seeking medical
advice and treatment.
Analysis of the nature of constipation showed the
predominance of patients with constipation of an
organic nature. When distributing constipation by
origin, functional constipation accounted for 22 (15%),
and organic - 127 (85%), which is due to the fact that
before hospitalization, patients undergo a partial
examination on an outpatient basis (Fig. 1).
Fig.1. Distribution of patients depending on the origin of constipation
For the diagnosis, the classification of A.I. Khavkin
(2000) was followed, which identifies the following
criteria for determining: compensated - stool 1 time in
2-3 days, as a rule, independent, but with a feeling of
incomplete emptying and flatulence - 52 (34.9% );
subcompensated - stool 1 time in 3-5 days while taking
laxatives and cleansing enema - 74 (49.7%);
decompensated - there is no independent stool, its
delay can reach 10 or more days, accompanied by
Функциональные
Органические
Total:
-
45
30.2%
65
43.6%
32
21.4%
7
4.8%
149
(100%)
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Publisher:
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abdominal pain, intoxication, emptying is possible
using siphon or hypertonic enemas - 23 (15.4%).
Fig.2.Distribution of patients depending on the stage of colostasis
The predominance of the compensated and
subcompensated stages of constipation in the
examined sick children was established (Fig. 2).
In our studies, 149 examined patients revealed the
following comorbidity in constipation (Table 2), which
affected the course of the underlying disease.
The frequency of comorbidity in sick children with colostasis
table 2
Nosology
Number of patients
abs
%
Anemia
40
26.8
Hirschsprung disease
10
6.7
Dolichosigma
56
37.6
Dolichocolon
28
18.9
Megacolon
27
18.2
Payer's disease
7
4.7
34.90%
49.70%
15.40%
Компенсация
Субкомпенсация
Декомпенсация
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Chilaidity Syndrome
3
2.0
Ectopia ani
2
1.3
Atresia ani et recti
1
0.7
ani stenosis
3
2.0
SPO BPPR*
14
9.4
Total
191
* note: SPO BPPR - Condition after abdominal-perineal proctoplasty for Hirschsprung's disease, anorectal
malformation, etc.
CONCLUSIONS
Thus, on the basis of the results of the study and the
study
of
regional
characteristics
of
chronic
constipation in the Bukhara region, it was established
that when distributed by sex and place of residence,
boys are more likely to suffer, from the age of one year
to 9 years of age. Among the causative factors leading
to constipation, the highest frequency is represented
by the pathology of the sigmoid colon (dolichocolon,
megacolon, dolichosigma) - 75.2% of cases.
All established confirms the importance of taking
preventive measures to prevent constipation in
children. 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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