The total length of the human small intestine, its sections and functions. What is dolichosigma intestinalis

Intestines (lat. intestinum)- part of the gastrointestinal tract starting from the pylorus of the stomach and ending with the anus. The intestines digest and absorb food, synthesize some intestinal hormones, and also play an important role in immune processes. Located in the abdominal cavity.

Total intestinal length is about 4 m in a state of tonic tension (during life), and about 6-8 m in an atonic state (after death). In a newborn, the length of the intestine is 340-360 cm, and at the end of the first year it increases by 50% and exceeds the child’s height by 6 times. Moreover, the increase is so intense that from 5 months to 5 years of age, the length of the intestine increases 7-8 times, while its length in an adult is only 5.5 times greater than height.

The shape, position and structure of the intestines change depending on age. The intensity of its growth is greatest at the age of 1-3 years due to the transition from milk nutrition to mixed and general food. The increase in intestinal diameter is most pronounced in the first two years of life, after which it slows down until the age of 6, and later increases again. The length of the small intestine (intestinum tenue) in an infant is 1.2-2.8 m, and in an adult - 2.3-4.2 m. Its width in infancy is 16 mm, and at 23 years - 23 mm. It is divided into the duodenum (duodenum), jejunum (jejunum) and ileum (ileum). The duodenum of a newborn has a semicircular shape and is located at the level of the I lumbar vertebra, but at the age of 12 years it descends to the level of the III-IV lumbar vertebra. The length of the duodenum after birth is 7-13 cm and remains the same until 4 years of age. In small children, the duodenum is very mobile (13,14), but by the age of 7, adipose tissue appears around it, which fixes the intestine and reduces its mobility. In the second half of the year after birth, the small intestine is divided into the jejunum and ileum. The jejunum occupies 2/5 - and the ileum - 3/5 of the small intestine without the duodenum. The small intestine begins on the left at the level of the lumbar vertebra (with flexura duodenojejunal) and ends with the entry of the ileum into the cecum on the right at the level of the IV lumbar vertebra. A fairly common Meckel's diverticulum (a remnant of the ductus omphaloentericus) is located at a distance of 5-120 cm from the bauhinian valve.

Anatomically, the intestines have the following segments:

• (lat. enterum);
• (lat. colon).

Small intestine is a section of the human digestive system located between the stomach and large intestine. The process of digestion mainly occurs in the small intestine. The small intestine is called small because its walls are less thick and durable than the walls of the large intestine, and also because the diameter of its internal lumen, or cavity, is also smaller than the diameter of the lumen of the large intestine.

The small intestine has the following subsections:

• (lat. duodenum);
• jejunum (lat. jejunum);
• ileum (lat. ileum).

Colon- this is the lower, terminal part of the human digestive tract, namely the lower part of the intestine, in which water is mainly absorbed and formed feces are formed from food gruel (chyme). The large intestine is called thick because its walls are thicker than the walls of the small intestine due to the greater thickness of the muscle and connective tissue layers, and also because the diameter of its internal lumen, or cavity, is also greater than the diameter of the internal lumen of the small intestine.

The colon has the following subsections:

• (lat. caecum) with a vermiform appendix (lat. appendix vermiformis);
• colon (lat. colon) with its subsections:
  • (lat. colon ascendens),
  • (lat. colon transversum),
  • (lat. colon descendens,
  • (lat. colon sigmoideum)
• , (lat. rectum), with a wide part - the ampulla of the rectum (lat. ampulla recti), and a terminal tapering part - the anal canal (lat. canalis analis), which ends (lat. anus).

Small intestine length fluctuates between 160-430 cm; in women it is shorter than in men. The diameter of the small intestine in its proximal part is on average 50 mm, in the distal part of the intestine it decreases to 30 mm. The small intestine is divided into the duodenum, jejunum and ileum. The jejunum and ileum are mobile, lie intraperitoneally (intraperitoneal) and have a mesentery, which is a duplication of the peritoneum. Between the layers of the mesentery there are nerves, blood and lymph vessels, lymph nodes and fatty tissue.

The large intestine is long equal on average to 1.5 mm, its diameter in the initial section is 7-14 cm, in the caudal section - 4-6 cm. It is divided into 6 parts: the cecum, the ascending colon, the transverse colon, the descending colon, the sigmoid colon and the rectum . A vermiform appendix extends from the cecum, which is a rudimentary organ, which, according to a number of authors, has important functional significance as a lymphoid organ. The transition of the ascending colon into the transverse colon is called the right, or hepatic, flexure of the colon; the transition of the transverse colon into the descending colon is called the left, or splenic, flexure of the colon.

The intestine is supplied with blood from the superior and inferior mesenteric arteries. The outflow of blood occurs through the superior and inferior mesenteric veins, which are tributaries of the portal vein.

Sensitive innervation of the intestine is carried out by sensory fibers of the spinal and vagus nerves, motor - by sympathetic and parasympathetic nerves.

The walls of the small and large intestines consist of the mucous membrane, submucosa, muscular and serous membranes. The intestinal mucosa is divided into epithelium, lamina propria and muscular plate.

Mucosa of the small intestine forms villi - outgrowths protruding into the intestinal lumen. There are 20-40 intestinal villi per 1 mm2 of surface; in the jejunum there are more of them and they are longer than in the ileum. Intestinal villi are covered with bordered epithelial cells, the outgrowths of their plasma membrane form many microvilli, due to which the absorption surface of the small intestine sharply increases. In the lamina propria of the mucous membrane there are tubular depressions - crypts, the epithelium of which consists of argentaffinocytes, borderless enterocytes, goblet and Paneth cells, producing various ingredients of intestinal juice, incl. mucus, as well as intestinal hormones and other biologically active substances.

Colon mucosa It is devoid of villi, but contains a large number of crypts. In the lamina propria of the mucous membrane of the K. there are accumulations of lymphoid tissue in the form of single and group lymphatic (Peyer's patches) follicles. The muscular lining of the intestine is represented by longitudinal and circular smooth muscle fibers.

Physiology of the intestine. The process of digestion in the intestines begins in the cavity of the small intestine (cavitary digestion). Here, with the participation of pancreatic enzymes, complex polymers (proteins, fats, carbohydrates, nucleic acids) are hydrolyzed into polypeptides and disaccharides. Further breakdown of the resulting compounds to monosaccharides, amino acids, fatty acids and monoglycerides occurs on the wall of the small intestine, in particular on the membranes of the intestinal epithelium (membrane digestion), with an important role played by the intestinal enzymes themselves.

Most substances are absorbed in the duodenum and proximal jejunum; vitamin B12 and bile acids are in the ileum. The most important mechanisms of absorption into the intestine are active transport, carried out against a concentration gradient using energy released during the breakdown of phosphorus compounds, and diffusion.

Various types of intestinal contractions (rhythmic segmentation, pendular, peristaltic and antiperistaltic contractions) contribute to the mixing and grinding of intestinal contents, and also ensure its advancement. In the colon, water is absorbed, dense contents are formed and evacuated from the body. The intestines are directly involved in metabolism. Here, not only the digestion and absorption of nutrients with their subsequent entry into the blood occurs, but also the release of a number of substances from the blood into the intestinal lumen with their further reabsorption.

One of the most important is the endocrine function of the intestine. Intestinal cells synthesize peptide hormones (secretin, pancreozymin, intestinal glucagon, gastroinhibitory polypeptide, vasoactive intestinal peptide, motilin, neurotensin, etc.), which regulate the activity of the digestive system and other body systems. The largest number of such cells is concentrated in the duodenum. The intestines take an active part in immune processes. Along with the bone marrow, spleen, lymph nodes, and bronchial mucosa, it is a source of immunoglobulins; Various subpopulations of T-lymphocytes are also found in the intestine, with the help of which cellular immunity is realized.

Many intestinal functions (protective, vitamin synthesis, etc.) are closely related to the state of the intestinal microflora, which is normally represented predominantly by anaerobes.

Bowel research methods. Anamnesis is of great importance in recognizing intestinal diseases. Local (intestinal) and general complaints are identified. Pay attention to the characteristics of the stool (the amount and nature of feces, the frequency of bowel movements, the occurrence of a feeling of relief after defecation, accompanying phenomena), the presence and nature of abdominal pain, their connection with stool and food intake, flatulence, rumbling and transfusion in the abdomen. They establish intolerance to a particular food (milk, dairy products, vegetables, etc.), the impact of mental factors (emotional stress, conflicts) and their connection with the appearance of intestinal disorders. The patient is asked about the daily rhythm of symptoms (for example, night pain, morning diarrhea), and in case of a long-term process, about their dynamics.

When familiarizing yourself with general complaints, you can identify symptoms that occur, for example, with damage to the small intestine. These include general weakness and weight loss, dry skin, hair loss, increased brittleness of nails, menstrual disorders, decreased libido, etc.

During examination, pay attention to the shape of the abdomen and intestinal peristalsis.

Using superficial palpation, areas of pain and tension in the muscles of the anterior abdominal wall are identified. The small intestine, with the exception of the terminal segment of the ileum, cannot be palpated. Deep palpation is used to identify pathology of the colon. At the same time, the features of all its parts (shape, size, mobility, pain, splashing noise) are consistently determined.

Auscultation reveals rumbling and transfusion caused by peristalsis and the passage of gas bubbles through the intestines, increasing, for example, with stenosis and weakening with intestinal paresis.

A valuable method is digital examination of the rectum. Coprological examination is of great importance, including macroscopic, microscopic, chemical, bacteriological studies, as well as the determination of helminths and protozoa. Various functional research methods have been developed to assess the state of basic intestinal functions. To study digestive function, the degree of increase in blood sugar levels after a load of lactose and other disaccharides is determined. More accurate methods are based on determining the activity of intestinal enzymes in the intestinal mucosa using enterobiopsy.

To study the absorption function of the intestine, a load of food monomers (monosaccharides, amino acids, etc.) is used, followed by determination of the increase in their content in the blood. A test is also carried out with D-xylose, which is practically not utilized by body tissues. By the amount of D-xylose excreted in the urine over a certain period of time (usually within 5 hours after its intake), absorption processes in the small intestine are judged. Determining the concentration of D-xylose in the blood is also of diagnostic importance.

Radioisotope techniques are also used, which consist in measuring the radioactivity of feces some time after loading with radioactive substances, for example, lipids labeled with radioactive isotopes. The higher the radioactivity of the stool, the more impaired the absorption function of the small intestine. The study of intestinal motor function is carried out by recording changes in intraintestinal pressure and electrical potentials associated with intestinal motor activity, using the balloon-kymographic method or using open catheters. Motor activity can also be judged by the speed of movement of a radiopaque substance through the intestines or by the timing of the excretion of non-absorbable markers in the feces - carmine, carbolene, etc. For a more detailed study of a number of intestinal functions, incl. processes of digestion and absorption, probing (intubation) of various parts of the intestine is carried out using multi-channel probes that are inserted through the mouth or rectum. One of the probe channels ends in a thin-walled balloon. When a balloon is inflated, a closed segment is created in one or another part of the intestine, into which a solution containing the test substances and a non-absorbent marker (usually polyethylene glycol) is injected. Comparison of the concentration of the marker and the test substance in the aspirated liquid makes it possible to determine the intensity of absorption (jejunoperfusion method).

X-ray examination plays a leading role in the diagnosis of intestinal diseases. X-ray methods for examining the intestines are divided into non-contrast and those performed using radiopaque agents. The first include survey fluoroscopy and radiography of the abdominal cavity, which make it possible to detect free gas in the abdominal cavity during perforation of the intestinal wall, foreign bodies, pathological accumulations of gas and liquid in the bowel when it is obstructed, etc. A contrast study of the small intestine is usually performed by filling it with a suspension barium sulfate. 10-15 minutes after ingestion of the radiopaque substance, an image of the first loops of the jejunum appears, and after 1.5-2 hours - all other parts of the small intestine. In order to speed up the filling of the small intestine with a radiopaque substance (provided that non-motor function is being examined), the barium suspension is pre-cooled to 4-5°, and drugs that stimulate intestinal motor function are administered (0.5 mg proserin subcutaneously, 20 mg metoclopramide intravenously). The examination of the small intestine is carried out in both a vertical and horizontal position of the patient; along with fluoroscopy, survey and targeted radiography are performed. In some cases (for example, for uniform tight filling of the small intestine and its double contrast), transprobe enterography is used - the introduction of a radiopaque substance using a probe previously inserted through the mouth into the small intestine. Filling of the intestinal loops is carried out under fluoroscopy control, images are taken in different positions of the patient. To relax the intestinal race, 10-15 minutes before the study, the patient is injected with 1 ml of a 0.1% solution of atropine sulfate intravenously or 2 ml of a 0.1% solution of metacin under the skin. X-ray examination of the small intestine is contraindicated in extremely severe general condition of the patient; A relative contraindication is acute mechanical intestinal obstruction. 5-7 hours after taking a suspension of barium sulfate, the ileocecal angle can be examined, and after 24 hours, the colon. Filling the colon with a radiopaque substance through the mouth makes it possible to evaluate mainly its motor-evacuation function, as well as its shape, position, lumen size, displacement, and haustration. Transoral examination of the colon is usually used in case of prolonged persistent constipation or diarrhea, suspected pathology of the ileocecal region, in particular in chronic appendicitis and Crohn's disease. The main x-ray method for examining the relief of the colon is irrigoscopy. X-ray signs of intestinal damage are changes in its contours, the presence of filling defects, changes in the relief of the mucous membrane, disturbances in tone, peristalsis, and passage of the radiocontrast substance. An important role belongs to endoscopic methods - intestinoscopy, colonoscopy, sigmoidoscopy. Intravital morphological examination of the intestinal mucosa is carried out using a biopsy or aspiration technique.

Intestinal pathology The leading symptoms of intestinal pathology include bowel disorders.

Diarrhea arise due to increased intestinal secretion and decreased absorption function of the intestine. In some forms of pathology, the cause of diarrhea is an increase in intestinal motor activity. In case of dysfunction of the small intestine, it is characterized by a moderate increase in stool frequency (no more than 3-4 times a day), an increase in the volume of feces, the presence of undigested food residues in the feces and an increased fat content (steatorrhea), as a result of which it smears the toilet. In diseases of the colon, stools are very frequent, but scanty; there may be blood in the stool, but there is no steatorrhea or visible remains of undigested food.

Constipation are caused by increased motility (non-propulsive peristaltic and anti-peristaltic contractions) or a weakening of intestinal motor activity with subsequent coprostasis. Persistent constipation is observed with intestinal atony, which occurs due to chronic diseases of the intestine, accompanied by damage to the muscular lining or disruption of neurohumoral regulatory mechanisms. In acute infectious processes, intoxications, and neurological disorders, constipation may be observed due to intestinal paresis - an acute disturbance of intestinal motility.

Pain in the intestines most often associated with increased pressure in the small or large intestine, which can be caused by spasms, convulsive contractions of intestinal smooth muscles, and accumulation of gases. They can also be caused by impaired blood supply to the intestines, irritation of nerve receptors during inflammatory processes in the intestines. In diseases of the jejunum, pain is usually localized in the umbilical region, in ileitis - in the right iliac region, in diseases of the left half of the colon - in the lower abdomen, more often on the left, in diseases of the right half of the colon - in the right iliac region and right lateral abdomen . The nature of the pain may vary. The pain can be constant or intermittent. With flatulence, they are most often long-lasting and monotonous, increasing towards the end of the day, decreasing after stool and passing gas. Sometimes patients are bothered by severe cramping pain that occurs suddenly in different parts of the abdomen (intestinal colic). Pain can intensify with physical activity, shaking, defecation, during an enema; such increased pain is observed with mesenteric lymphadenitis, peri-process. Damage to the distal parts of the colon is characterized by tenesmus - a painful urge to defecate with insufficient discharge or no discharge of contents at all. An important sign of damage to the small intestine are syndromes characterizing intestinal dysfunction. Digestive insufficiency syndrome is a clinical symptom complex caused by impaired digestion due to a deficiency (congenital or acquired) of digestive enzymes, most often lactase, less often other disaccharidases. Manifested by diarrhea, nausea, vomiting, polyfecal matter and other dyspeptic disorders that occur when consuming dairy products or foods containing other disaccharides. Malabsorption syndrome (congenital or acquired) is manifested by a variety of symptoms, which is caused by a violation of all types of metabolism. The syndrome of exudative enteropathy (primary or secondary), resulting from increased permeability of the intestinal wall, the release of protein from the bloodstream in the intestine and its loss in feces, is characterized by hypoproteinemia, edema, ascites, the appearance of effusion in the pleural cavities, and degenerative changes in internal organs. Often all of these syndromes are observed simultaneously; in these cases they talk about enteral insufficiency.

Which doctors should I contact for an examination of the Intestines:

Gastroenterologist

What diseases are associated with the intestines:

What tests and diagnostics need to be done for the Intestines:

X-ray of the intestines

CT bowel

MRI of the abdominal organs

Angiography of the mesenteric vessels

– an abnormal increase in the length of the sigmoid colon and its mesentery, leading to impaired motility and bowel movement. Dolichosigma is manifested by chronic constipation, flatulence, and recurrent abdominal pain. In the diagnosis of dolichosigma, the main role is played by irrigography and radiography of the passage of barium through the large intestine; auxiliary - rectosigmoidoscopy, colonoscopy, etc. For dolichosigma, diet, massage, exercise therapy, and physiotherapy are prescribed; for prolonged constipation - laxatives and enemas. In case of chronic intestinal obstruction, dolichosigmoid resection is performed.

Due to a long absence of bowel movements, a child with dolichosigma may form fecal stones, develop fecal autointoxication, anemia, and irritable bowel syndrome. One of the serious complications of dolichosigma is intestinal obstruction due to nodulation, volvulus, kinks, and intussusception of the sigmoid colon. In these cases, a picture of an acute abdomen develops.

Diagnosis of dolichosigma

Examination of a child suffering from dolichosigma reveals underweight, retarded physical development, and pale skin. Palpation of the abdominal cavity reveals intestinal loops filled with feces. A digital rectal examination reveals an empty rectum, even if the child has not had stool for a long time.

The decisive instrumental method in the diagnosis of dolichosigma is irrigography, during which the elongation of the sigmoid colon is revealed, the presence of additional loops in the form of a “figure eight”, “double-barrel”, “knot”, “snail”, etc. MSCT of the colon allows you to study its location in detail , shape, contours, length, lumen width, haustration, presence of additional loops.

To assess the motor-evacuation function of the colon in a patient with dolichosigma, barium passage radiography, electromyography, and sphincterometry are performed. Endoscopy in children (rectosigmoscopy, colonoscopy), ultrasonography of the large intestine, ultrasound of the abdominal cavity, radiography of the abdominal cavity are of auxiliary importance in the diagnosis of dolichosigma. Among laboratory methods, a coprogram is used; stool analysis for dysbiosis, occult blood, helminth eggs; clinical and biochemical blood tests.

Dolichosigma in children should be differentiated from ulcerative colitis, Crohn's disease, enterobiasis, chronic appendicitis, Hirschsprung's disease. For this purpose, the child should be consulted by a pediatric gastroenterologist, pediatric coloproctologist, and pediatric surgeon.

Treatment of dolichosigma

At any stage of dolichosigma, treatment begins with complex conservative therapy. The leading role in therapeutic measures is given to the normalization of the digestive tract through diet - fractional meals, consumption of foods rich in fiber (vegetables, whole grain bread, bran, fruits, berries, herbs), fermented milk products, vegetable oils, etc. In some cases, laxatives are prescribed and microenemas, however, with dolichosigma it is extremely important to form a reflex to spontaneous defecation.

For spastic pain, antispasmodics (drotaverine, platyphylline) are prescribed; for intestinal hypotension - prozerin, massage of the anterior abdominal wall, exercise therapy, electrical stimulation of the colon, colon hydrotherapy, acupuncture. Patients with dolichosigma benefit from courses of vitamin therapy (B6, B12, C, E), bacterial preparations (probiotics and prebiotics), and treatment in sanatoriums in Zheleznovodsk and Truskavets.

Indications for surgical treatment of dolichosigma in children are extremely rare. Surgical treatment is indicated for intestinal obstruction, failure of conservative therapy, persistent constipation, progressive fecal intoxication, the presence of unstraightened loops and kinks of the intestine. With dolichosigma, resection of the sigmoid colon is performed. In the case of predominant damage to the distal sigmoid colon, the operation of choice is proctosigmoidectomy.

Forecast

Usually, if all medical recommendations are followed, it is possible to achieve regular independent bowel movements and an acceptable quality of life. As the child grows, many disorders can be compensated; in some cases, the problem of dolichosigma worries patients even in adulthood. In the latter case, lifelong adherence to the diet and quality of nutrition is necessary, to exclude the development of nutritional, psychogenic and other types of constipation. Children with dolichosigmoid need observation by a pediatrician, pediatric gastroenterologist, periodic courses of conservative therapy, and examination of the condition of the large intestine.

The sigmoid colon is an S-shaped segment of the digestive canal, 24-46 cm long and 4 cm wide, where water and vitamins are absorbed. For each person, this part of the large intestine differs in some anatomical features. Cases of its abnormal lengthening are called dolichosigma.

Without unpleasant symptoms, the condition is considered normal. If it is accompanied by prolonged constipation, flatulence, recurrent abdominal pain, then it is already called a pathology and requires adequate treatment. Many people have not heard much about this rare disease, although its destructive effects on digestion and the body as a whole deserve close attention. So we will look at what an elongated intestine is and how to treat it.

What is dolichosigma

This is a defect of the large intestine that causes its excessive mobility, as a result of which serious problems arise with the formation and passage of feces. The incidence of pathology in the adult population is quite high and amounts to 25%, although the real figures are much higher. Reasons: difficulties in diagnosis and erased symptoms. In childhood, dolichosigma is found in 40% of cases associated with constipation.

Causes of the disease

Dolichosigma is characterized by an unclear etiology. It can be congenital and caused by a number of factors, among which the most significant are:

• Genetic predisposition.
• The impact of unfavorable conditions on the embryonic development of the fetus.
• Past infections and taking certain medications during pregnancy.

The reasons for the acquired form of elongated sigma are:

• Prolonged rotting of food in the intestines.
• Physical inactivity.
• Abuse of carbohydrates and proteins.
• Stress.
• Age over 50 years.

The motility of the digestive canal weakens due to secondary changes in the intestine, including:

• Dystrophy of the mucous membrane.
• Overgrowth of muscle tissue.
• Disturbances in the structure of the mesentery.

According to some experts, dolichosigma is always congenital, and the manifestation of its manifestations occurs due to problematic digestion and anatomical defects. Until now, proctologists cannot come to a consensus on whether dolichosigma is a defect or is considered normal.

Symptoms

Among the main signs of the disease are:

• Prolonged constipation, the number of which increases over time. There may be no stool for a week, and sometimes even a month.
• Stagnation of feces leads to poisoning of the body.
• Pain with difficult localization. It intensifies over time.
• Flatulence.
• Bloating.
• Problems with appetite.

Accurate diagnosis

It begins with an examination of the patient by a doctor who collects data on complaints, operations and previous diseases. Thanks to the analysis of family history, the specialist determines the genetic predisposition to anomalies in the structure of the sigmoid. The doctor palpates the abdomen and, if pathology is present, detects pain in the area to the left of the navel.

Laboratory diagnostic methods make it possible to evaluate the composition of blood and feces, which can already be used to judge the presence of inflammatory processes, hemoglobin levels, and the concentration of basic microelements.

Instrumental diagnostic methods are prescribed:

• Sigmoidoscopy with visualization of the mucous membrane of the lower parts of the digestive canal.
• Colonoscopy with examination and biopsy of the intestinal wall.
• Irrigography with contrast to identify its narrowed or expanded areas.
• X-ray examination with detection of characteristic sigma loops.
• Ultrasound and multislice computed tomography.

Stages and possible complications

Dolichosigma proceeds through 3 stages:

• Compensated, with pain in the lower abdomen due to periodic constipation lasting 3 days. The patient's condition improves after taking laxatives and following a diet.
• Subcompensated, characterized by flatulence and constant constipation. Enema and medications with a laxative effect help.
• Decompensated, which is characterized by delayed defecation for up to a week, bloating, accompanied by constant severe pain. The consequence of poisoning of the body is skin lesions with the appearance of pustules, nausea, and lack of appetite. Relief occurs after a siphon enema.

Ignoring the problem can cause complications, including:

• Irritable bowel syndrome, accompanied by abdominal discomfort, flatulence and other functional digestive disorders.
• Skin rashes.
• Anemia.
• Weight loss.
• Problems with intestinal patency.
• Cracks in the walls of the stomach and bleeding.
• The formation of dense, dry fecal stones from stagnant feces, which makes independent defecation difficult.
• Poisoning of the body with toxic products of decay due to their reabsorption into the blood.

Treatment of dolichosigmoid intestines

Therapy begins with determining the clinical stage of the disease and registering the patient with a dispensary.

Medicines

The treatment regimen consists of repeated courses and is carried out conservatively if there is no threat to the life and health of the patient. For hypotension of the digestive canal, the doctor prescribes: Prozerin course of 2-3 weeks, taking vitamins B6, B12, E and C, reflexology, electrical stimulation of the large intestine (consisting of 15 procedures, one each day).

If necessary, treatment in adults is carried out using sleeping pills and sedatives, as well as antispasmodics (No-spa and Platyfillin), defoamers, pre- and probiotics, prokinetics, saline laxatives to increase stool volume.

To consolidate the achieved positive results, treatment in specialized sanatorium-resort complexes is recommended.

Folk remedies

Subject to a special diet and medical recommendations, dolichosigma can be treated with home recipes, but only after the doctor’s approval. To get rid of constipation prepare:

• A decoction of 250 ml water and 2 tbsp. l. buckthorn fruit. After 2 hours of infusion, drink a third of a glass before bed. Will lead to a successful morning bowel movement.
• Take cabbage juice 0.5 tbsp. within 3 weeks.
• A mixture of yarrow, caraway, buckthorn and watch (2:1:5:2). Pour one tablespoon of herbal mixture into a glass of boiling water, after infusing and straining, divide the resulting volume by 3-4 times.
• A remedy made from 250 ml of boiling water and 1 tbsp. l. raisins Leave for an hour. Can be given to a child.

Exercises

When diagnosed with dolichosigma intestines, professional sports and intense physical activity are contraindicated, but walking, not very long jogging, swimming, morning exercises and sets of special exercises are useful. They normalize intestinal function and improve the general condition of a person.

In the morning, without getting out of bed, you can perform a complex of physical therapy consisting of the following exercises:

• Sitting on the edge of the sofa, raise your arms, your left leg too, while lowering your right leg and using your torso movements, strive for the limbs to meet. Perform 10 times.
• Sitting on the bed, feet shoulder-width apart. Try to touch your right knee with your left elbow.
• Hands behind head. Legs are bent at the knees and raised at a right angle. Perform knee turns in one direction or the other.
• Hold the headboard with your hands. Rotate your feet, keeping your legs straight and closed.
• The starting position is the same. The left leg is placed on top of the right, foot down, trying to reach the bed.

The problem of prolonged constipation is eliminated by doing regular squats every day.

Exercises in combination with massage give good results, for example, in a standing position, tilt your torso forward, rest your fists on the area on both sides of the navel and make rotational and pressing movements. Simple exposure to the peritoneal area is ineffective.

Operation

Surgical intervention is prescribed in the case of complicated dolichosigma, which does not respond to drug therapy, and its symptoms affect the patient’s work and social activity. In exceptional cases, an operation is performed to resect excess loops and kinks that cannot be straightened, or the entire intestine. It is indicated for progressive long-term and persistent constipation, a sharp weakening of reflexes in response to mechanical stimuli, expansion of the sigmoid, persistent damage to the muscular system and nervous regulation. The endoscopic detorsion method is used in case of sigmoid torsion.

Diet for illness

Nutritional correction is part of the treatment of the uncomplicated form of dolichosigma. The patient's condition improves by observing the water-salt regime and consuming foods high in fiber: honey, fruits, kvass, rye bread and raw vegetables. Your diet should include potato dishes instead of flour products.

Very often, parents turn to the pediatrician with complaints that the child has been constipated for several days. One of the causes of long-term constipation in children is dolichosigma; in this condition, the child’s intestines are longer than normal. Dolichosigma means "long sigmoid colon." Most often, this is a congenital elongation of the sigmoid colon, through which feces pass with difficulty due to its tortuosity. Only a doctor can make this diagnosis. Parents need to know what normal stool should be like in a child of different ages and what exactly constitutes constipation, and what symptoms should alert them.

Normal stool in children of different ages.

From the first days of life, the baby’s digestive system begins to work. The quantity and quality of bowel movements can be used to judge the functioning of the gastrointestinal tract. Immediately after birth, the baby's feces are a mushy mass of black-green color, the so-called meconium - the result of the baby's nutrition in the womb. Such feces are observed during the first three days. Then the color changes and becomes gray or gray-green, which indicates good digestibility of mother's milk. The number of bowel movements can be from once a day to 10-12. Starting from the second week, the baby poops several times, but at least once a day. And if the stool is not hard, but of the same consistency, has a yellow or yellowish-brown color and a sour smell, there is no reason to worry. After introducing complementary foods from 4–5 months, stool has an unpleasant odor, resembles putty, and the color becomes brown with dark patches. The normal frequency of bowel movements in a child is 4 to 10 times a day. Although doctors are now of the opinion that if a child under 4-6 months poops once every 2-3 days, a mushy mass without a putrid odor, but the baby is active, has no symptoms of anxiety, and his tummy is soft, then his digestive system is working Fine.

Up to one and a half years, the stool has a mushy consistency, up to two years it can be different, and after that the stool should be formed. However, it is necessary to monitor the baby's bowel movements and take into account the quantity, smell, consistency and color of the bowel movements, as well as the general condition of the baby. Parents often consult a doctor about the absence of bowel movements in their child for some time.

Constipation in a child. Causes.

Constipation is the absence of bowel movements in a child during the day or an increase in the time between trips to the potty. At the same time, the child poops with difficulty and complains of pain during bowel movements, and then is completely afraid to walk “in a big way.” It is always necessary to check the consistency of stool. If you notice that there are fewer stools, and they have a “large diameter” and dense consistency, or are divided into small peas and have a putrid odor, you should consult a doctor.

Constipation in a child of the first year of life can be functional, that is, associated with imperfection of the neuromuscular system and dysregulation of the intestines. This constipation occurs for the following reasons:

• improper nutrition of a nursing mother;
• insufficient water intake by the child;
• incorrect transfer to artificial feeding;
• poor nutrition of children in the first year of life;
• consequences of damage to the fetal nervous system during pregnancy;
• one of the symptoms of rickets, anemia, hypothyroidism and food allergies in children;
• use of certain medications;
• the presence of worms in children.

With proper nutrition, normalization of the water and nutritional regime and elimination of the underlying diseases that cause constipation, the act of defecation is normalized.

Organic constipation is associated with a defect or underdevelopment of a section of the large intestine or acquired pathological changes: tumors, polyps, adhesions.

Long sigmoid colon

This pathology is quite common - in 25% of children, the cause of constipation is dolichosigma. This is due to the influence of unfavorable factors on the development of the child during pregnancy: drugs, chemical poisoning, poor ecology, radiation, abuse of sunbathing, viral infections, especially if the pregnant mother had rubella after 20 weeks. The diagnosis of dolichosigma can be made if there is severe pain and severe bowel disorders in the form of constipation.

The sigmoid colon is a section of the large intestine that is located in the pelvis. It got its name because of its appearance - like the Latin “sigma” or S. In newborns its length is 15–20 cm, in a year – 25–30 cm, and in 10 years – 37-38 cm. The continuation of this section is the rectum.

With dolichosigma, the length of this intestine in newborns can reach up to 1 meter and have several loops, which impairs the patency of feces. Moreover, it can wander throughout the entire abdominal cavity, and when symptoms appear, appendicitis, renal colic, and other diseases are suspected.

When the famous Ilya Ilyich Mechnikov was awarded the Nobel Prize for his proposals to give ordinary curdled milk to patients with intestinal dysfunction, the poet Alexander Blok presented the scientist with his poems with the inscription: “Isn’t it possible to measure all our melancholy with a gut?” Like this! The long intestine is dolichosigma, a symbol of bitterness and despondency.

Symptoms of this pathology may never appear, and a person can live his entire life without knowing about his defect. But dolichosigma most often manifests itself as constipation, which bothers children from the first days of life. However, the diagnosis can only be made at 2–3 years of life, since constipation after birth is regarded as an error in the transfer to artificial feeding or due to improper introduction of complementary foods.

At first, constipation is rare, then it becomes more frequent and painful and becomes permanent. The child complains of constant pain in the abdomen, as well as during bowel movements. The pain intensifies after a heavy lunch or dinner and almost stops after the potty. By palpating the abdomen, the doctor can determine the cord below the navel and signs of flatulence. The feces are dense, have a putrid or fetid odor, sometimes even streaked with blood (if the intestinal mucosa is damaged). Dolichosigma is confirmed after irrigoscopy or x-ray. In the photographs, the intestine is long, its diameter is almost unchanged, but with a large number of loops and kinks.

There are three stages of the disease:

• Compensated. Constipation is a concern. A properly selected diet and taking mild laxatives normalizes the condition.
• Subcompensated. Constipation is more common and does not go away after taking laxatives. Cleansing enemas are required. Signs of intoxication appear: nausea, dry skin, headache, low-grade fever (37.1–37.5°C).
• Decompensated. Constant constipation. Severe intoxication of the body with nausea, vomiting, lack of appetite, anemia, weakness. It only helps.

A few words about enemas

Enemas are not a solution! With frequent use of enemas, the large intestine becomes “lazy,” that is, it does not respond to nerve impulses, and peristalsis stops. “Getting” such an intestine is problematic. Along with this, dysbacteriosis and vitamin deficiency develop due to the leaching of normal microflora and nutrients.

Treatment

Attentive parents consult a doctor during the first and second stages. The main treatment is to prescribe a diet or, more precisely, prescribe the right foods.

It is necessary to drink a large amount of liquid from 100 ml per kg of body weight of a newborn child to 1 liter per day for children 7-8 years old. Your doctor will tell you the exact amount. Warm mineral water containing sulfur is recommended: Borjomi, Essentuki No. 17.

The diet should consist of foods rich in fiber and pectin. These are fruits and vegetables. However, fresh apples and pears are not recommended - it is better to bake them. It is advisable to give vegetables in the form of puree, exclude fatty, fried, smoked foods. Recommended: rye or bran bread, fresh low-fat fermented milk products, decoctions of dried fruits and prunes. It is better to cook porridge from whole grains - wheat, buckwheat, oatmeal. It is recommended to give your child 10 g of olive oil and two tablespoons of bran daily.

Dolichosigma can also be treated with daily morning exercises with exercises on the abdominal muscles; massage of the anterior abdominal wall is necessary. Physiotherapy includes paraffin and ozokerite applications, warm, wet wraps, novocaine blockades, electrical stimulation of the intestines, and acupuncture.

Among the medications prescribed are vitamins C, E and group B or multivitamins, and. There is no convincing evidence base for use with dolichosigma in the world yet.

Usually, proper nutrition and compliance with the doctor’s recommendations allows you to achieve improvements in the child’s condition and eliminate constipation. In most cases, with the growth and development of the child, all symptoms are compensated. There are cases when constipation remains for life. In this case, all you need is proper nutrition and “fighting” constipation.

The question of surgery is raised extremely rarely and only in such cases: failure of conservative treatment, increasing intoxication, intestinal obstruction or intussusception (insertion of one part of the intestine into another - like a rolled-up stocking), persistent constipation, the presence of twisted loops and kinks in the sigmoid colon. In this case, resection (removal) of part of the intestine is performed.

Children with dolichosigma are seen by a pediatrician and pediatric gastroenterologist. Mothers ask whether dolichosigma can go away with age. The answer is clear - NO, dolichosigma is an anatomical feature. You are destined to live with this for the rest of your life. But the symptoms of constipation can decrease if you choose the right diet and improve your physical activity.

Health to you and your children!

Dear friends! Medical information on our website is for informational purposes only! Please note that self-medication is dangerous to your health! Sincerely, Site Editor

I was going to write a review about a new type of surgery on the intestines, but I thought that first I should talk about structure this very intestine. When I was in school, I sometimes got confused which intestine goes with which. Therefore, today we are closing this gap. You'll even find out which gut was named hungry and why.

Will short course in anatomy, get ready. I threw out the unnecessary, here - only the most interesting.

Human intestine consists of two departments - thin and thick. Why was it called that? The diameter of the small intestine is 4-6 cm at the beginning and gradually decreases up to 2.5-3 cm. The large intestine has average diameter 4-10 cm. Even a poor student can distinguish them by their appearance, but more on that below.

DIVISIONS OF THE INTESTINE
(the names are English, although they are similar to Latin)
Esophagus - esophagus.
Liver - liver.
Small intestine - small intestine.
Colon - colon(part of the large intestine).
Rectum - rectum.

When I was preparing this material, I almost got confused: the textbooks give different numbers about the length of the small intestine. The solution is simple: from a living person In humans, the length of the small intestine is 3.5 - 4 meters, A at the dead - about 6-8 m due to loss of intestinal tone, that is, 2 times more. Colon length much less - 1.5 - 2 meters.

Small intestine

The small intestine has 3 departments:

1. duodenum(lat. duodenum, read “duodenum”, stress everywhere on the penultimate syllable, unless I emphasized otherwise): the initial section of the small intestine, has the shape of the letter “C” and length 25-30 cm(21 cm in a living person), goes around the head of the pancreas, flows into it common bile duct And main pancreatic duct(sometimes there is an accessory pancreatic duct). The name is given according to the length of this intestine, which ancient anatomists measured on their fingers(no rulers were used). In ancient times in Rus' the finger was called finger(“index finger”).
2. jejunum(jejunum, eyunum - empty, hungry): represents upper half small intestine. Have you ever wondered why the intestine was called " hungry"? It’s just that at autopsy it often turned out to be empty.
3. ileum(ileum, Ileum - from the Greek ileos to twist): is bottom half small intestine. There is no clear boundary between the jejunum and ileum, and they themselves are very similar in appearance. Therefore, anatomists agreed that the upper 2/5 of the small intestine is the jejunum, A lower 3/5 - ileum. Calculate the length in meters yourself.

PARTS OF THE SMALL INTESTINE in Latin.
Duodenum - 12-ring intestine.
Jejunum- skinny intestine.
Ileum- ileum intestine.

Inflammation of the duodenum is called duodenitis(have you heard the term gastroduodenitis?). In practice, inflammation of the jejunum and ileum is not isolated separately, but is called a general term enteritis(inflammation of the small intestine) from Greek enteron- intestines.

Typical microscopic structure the intestinal wall is (from the inside out):

• mucous membrane,
• submucosa,
• muscle layer:
• internal circular (circular),
• external longitudinal (only three ribbons remain in the large intestine, more about them below),
• serous (outer) layer.

LAYERS OF THE INTESTINAL WALL
(See the pronunciation of Latin words in brackets, the rest - in the English-Russian dictionary)
Tunics - shells,
mucosa (mucosa) - mucous membrane,
submucosa (submucosa) - submucosa,
muscularis (muscular) - muscle layer(inner - internal, outer - external),
serosa (serosa) - serosa(here is the peritoneum),
mesentery - mesentery.

Mesentery(mesenterium, mezentErium) is a fold of peritoneum that attaches the intestines to the posterior wall of the abdominal cavity; vessels and nerves pass through it. You can compare the structure of the intestinal wall with the structure of the esophagus wall, which I wrote about earlier in the article about poisoning with vinegar essence.

Colon

Let's move on to large intestine. One of my favorite questions in anatomy is to name the external differences between the large intestine and the small intestine. There are 5 of them, if I haven't forgotten:

1. grayish color,
2. large diameter,
3. the presence of three longitudinal muscle bands(this is what remains of the longitudinal muscular layer of the wall),
4. Availability swelling(wall protrusions) - haustrum,
5. Availability omental processes(fat deposits).

FEATURES OF THE LARGE INTESTINE
(clockwise from its start)
Ileum - ileum,
Vermiform appendix - vermiform appendix (appendix),
Cecum - cecum,
Ileocecal valve - ileocecal valve,
Superior mesenteric artery - superior mesenteric artery,
Haustrum - haustra,
Right colic flexure - right colic flexure,
Transverse mesocolon - mesentery of the transverse colon,
Left colic flexure - left colic flexure,
Epiloic appendages - fatty deposits,
Tenia coli - muscle band,
Inferior mesenteric artery - inferior mesenteric artery,
Sigmoid mesocolon - mesentery of the sigmoid colon,
Rectum - rectum,
Anal canal - anal canal.

Colon has several departments:

1. cecum(cecum or caecum, tsekum): length 1 - 13 cm; This is the area of ​​the large intestine below the confluence of the ileum, that is, below the ileocecal valve. From the place where the three ribbons converge, a vermiform appendix (appendix) extends, which can be directed not only downwards, but also in any other direction.
2. ascending colon(colon ascendens, colon ascendens)
3. transverse colon(colon transversum, colon transversum)
4. descending colon(colon descendens, colon descent)
5. sigmoid colon(colon sigmoideum, colon sigmoideum): length is very variable, up to 80-90 cm.
6. rectum(rectum, rectum): length 12-15 cm. Diseases of this intestine are dealt with by doctors of a separate specialty - proctologists (from the Greek proktos - anus). I will not describe the structure of the rectum here; this is a complex topic.

PARTS OF THE LARGE INTESTINE(in order)
cecum - cecum,
ascending colon - ascending colon,
transverse colon - transverse colon,
descending colon - descending colon,
sigmoid colon - sigmoid colon,
rectum - rectum.

I explained the structure of the intestines in a simplified form. Students learn in more detail: how they are covered with peritoneum, whether they have a mesentery, how they are supplied with blood, what they border on, etc.

Inflammation of the large intestine is called colitis. Inflammation of the rectum should be called proctitis, but this term is rarely used. More often used paraproctitis- inflammation of the tissue around the rectum (a couple - about).

Addition dated February 29, 2008. Inflammation of the cecum is called typhlitis(from the Greek typhlon - cecum). You are unlikely to need the name, but I added it here to make the presentation encyclopedic.

What’s interesting: the small and large intestines differ not only in structure and function. They get sick in different ways. Diarrhea (diarrhea) with enteritis sharp in appearance different from diarrhea due to colitis. But more about this some other time. If anyone wants to read it. 🙂

Hello, doctors!! Maybe I’m a little late, but I hope that you are still visiting this page... I suspect that I have diseases that live in the small intestine. How effective are various enemas in this case, for example, garlic enemas in the amount of 1 glass? Do they reach to the small intestine? I also take garlic in a decent amount with food. Thanks in advance. Tatyana

Enemas will not be effective. Firstly, 1 glass is not enough for the liquid to reach even the middle of the large intestine. Secondly, between the small and large intestines there is an ileocecal valve, which will prevent the backflow of intestinal contents.

Thank you, doctor for the quick response!! The tests haven’t shown anything yet, I’ll test it in another 2 weeks, and we’ve already taken the pinworms that I saw in children 3 times, there are definitely no pinworms anymore, and my perineum itches in the evenings, that’s why I think maybe someone else is there! 😥 But I don’t want to wait for them to multiply!! I can’t even allow such a thought!! Thank you again, doctor!!

Hello! Very interesting information! Maybe you can help me with some advice? More than a year ago I had an irrigoscopy. The picture shows an extra loop of the sigmoid colon. And after this I have problems with the intestines: bloating, terrible, loud rumbling, loose stools (3-4 times a day), pain in the appendix area (removed) and just above the navel. I was treated for worms and took medications to restore the microflora, but the results were scanty. What can I do? Maybe it looks like cancer? Looking forward to your reply. Thank you.

You write as if the problems began after you found an extra loop of intestine. In fact, they appeared much earlier, which is why you had to do an irrigoscopy. Need to be examined further. Colonoscopy is more informative.

P.S. Comments will be closed in the future.