Diagnosis and treatment of chronic colostasis in children with dolichosigmoid

Abstract

Aim. To choose the proper tactics of constipation diagnosis and treatment in children with dolichosigmoid. Methods. 75 patents with various colonic diseases featured by constipation, were treated, dolichosigmoid was diagnosed in 36 (48%). All patients with dolichosigmoid were distributed to 3 groups. The first group included 22 (61.1%) patients with compensated stage, the second group - 9 (25%) with subcompensation, the third group included 5 (13.9%) patients with decompensated stage. The diagnosis was performed by anamnesis and results of clinical and laboratory examinations (blood analysis, urinalysis, stool analysis, intestinal microbiota test), fibrocolonoscopy was performed in 13 (36.1%), radiologic examination of colon - in 36 (100%), barium follow-through test - in 36 (100%), multispiral computed tomography with contrast media and virtual colonoscopy with 3D-reconstruction - in 8 (22.2%), sphincterometry - in 13 (36.1%), morphological examination of the biopsy samples obtained at fibrocolonoscopy - in 7 (19.4%), duplex ultrasonography of great intestinal vessels - in 9 (25%) of patients. Results. Out of 36 patients with dolichosigmoid, 29 (80.6%) received non-surgical treatment, remaining 7 (19.4%) children underwent surgery. One-stage sigmoid resection with colocolic end-to-end anastomosis formation was performed in 3 (8.3%) patients, one-stage left-sided hemicolectomy with colocolic end-to-end anastomosis formation - in 2 (5.6%), two-staged surgery - left-sided hemicolectomy with proctoplasty by Svenson-Chiatt-Isakov and colocolic end-to-end anastomosis formation - in 2 (5.6%). The best result was obtained in case of left-sided hemicolectomy, the sigmoid resection does not give a good result itself, with frequent relapses of constipation. Conclusion. The treatment of chronic colostasis should be started with non-surgical treatment, and only after rigorous evaluation; the indications for a surgical treatment are: subcompensated stage not responding to medical treatment and decompensated stage of the disease.