Megacolon

Megacolon - abnormal enlargement of the colon. Characterized by a thickening of the walls, the extension of the lumen and the lengthening of the entire large intestine or any part thereof; in further developing lobular inflammation and atrophy of the mucosa.
More common extension of the sigmoid colon (megasim) and at the same time elongation (Magdalinovka).


Bloating in the case of Girlspring.

There are acquired megacolon and birth. Purchased megacolon develops as a result of cicatricial stenosis of the lower section of the large intestine arise out of the inflammatory process, fistulas, injury, and secondary expansion of the overlying departments intestine. In the basis of congenital megacolon (disease Girlspring) is the lack of cells (eganglion) intramural nervous plexus in the wall of the rectosigmoid Department. This area, devoid of impellent innervation, usually narrowed and acts as organic obstacle. Congenital megacolon may appear in early childhood prolonged constipation, bloating (Fig.), fecal intoxication. Defecation have a putrid smell, contain mucus, blood, remains undigested food. Independent chair does not happen. Diagnosis is based on medical history, physical examination, rectoromanoscopy (see), x-ray contrast examination of the colon (the presence of narrow deprived of peristalsis of the plot ulcer below extended), biopsy.

Megacolon (megacolon, from the Greek. megas - large and kolon - colon; synonym of Girlspring disease) - abnormal increase in the size (length and mainly width) and hypertrophy of large intestine at more or less the part or all over (megapolitan). Often the changes are localized in the sigmoid colon (megasigmoideum, Magdalinovka, megasim). The disease is characterized by persistent constipation, increasing size of the stomach. A number of patients experiencing the attacks of intermittent bowel obstruction.
There are megacolon congenital and acquired. Congenital megacolon is the primary character or it can develop as a consequence of other congenital malformations; acquired megacolon always secondary origin. Adopted the following classification of megacolon.
1. Congenital megacolon. A. Primary: a) megapolitan - increasing the size of the colon with a predominant its lengthening; b) idiopathic megacolon. B. Secondary: a) congenital eganglion colon (disease Girlspring); b) congenital mechanical obstacle in the distal colon (attaching a form of atresia anus, stenosis of the rectum and others).
2. Purchased megacolon. A. Secondary megacolon as a result acquired mechanical obstacles in the distal colon (inflammation with scar formation, kinks, fistulas, tumors, trauma). B. Secondary M. as a result acquired destruction sites parasympathetic plexus (vitamin B1).
The greatest clinical significance is megacolon on the grounds of congenital agagliate the colon. The practical value of this form is very large, and the term "disease Girlspring" is often used synonymously with M
Pathogenesis. Cited arguments in favor of congenital underdevelopment muscular elements cancer, the presence of the folds of mucous membrane in its distal, kinks long sigmoid colon, congenital her atony, increased spasm of the sphincter of the anus, changes of tone of sympathetic nerve, etc., Studies of the Whitehouse and Kernohan (F. Whitehouse, J.W. Kernohan) and Svensson (O. Swenson) showed significant changes sites intermuscular (horbachevska) plexus and defeat Massarosa plexus "normal" distal colon.
Further studies show that this form of megacolon as congenital eganglion of part of the colon, in which peristalsis may not be exercised in those areas of the colon, where horbachevska plexus is missing. Heavy, up to death, changes muscle ganglionary zone (with the formation of irreducible homogeneous mass former muscular layers) exacerbate peristaltic disorders and make them permanent. Morphologically area is ganglionary, clinically - peristalticheskogo (Fig. 1).

Fig. 1. Colon 9 year-old girl died after a heavy mechanized enema edema of the brain and lungs. Visible funnel transition extended part in a narrow ganglionary (peristalticheskogo) zone.

Obezbecenje even small section of intestine always violates its permeability (see bowel Obstruction). Arising chronic (relative) obstruction is compensatory working hypertrophy of muscle tissue resulting intestine, and the coming eventually death exaggerated muscle fibers and their replacement by connective tissue lead to improvements in the colon over peristalticheskogo area. This extension is a sign of the coming of decompensation. Thus, megacolon in congenital agagliate develops secondarily.
Pathological anatomy. The study of pathological anatomy of the colon in congenital agagliate has allowed to allocate seven types of localization ganglionary zone (Fig. 2); most often it is localized in the perineal, ampullar rectum, rectosigmoidoscopy parts and distal or distal and proximal sigmoid colon. In addition, there are the so-called segmental ganglion, which is of two types: type a - ganglionary area does not apply to the rectum and is located in the upstream sections of the colon and type B - two ganglionary zone with a normal part of the colon between them.

Fig. 2. Types of localization ganglionary zone.