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

Intestine (lat. intestinum)- part of the gastrointestinal tract, starting from the pylorus and ending with the anus. Digestion and absorption of food takes place in the intestine, some intestinal hormones are synthesized, it also plays an important role in immune processes. Located in the abdominal cavity.

Total length of intestine 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 height of the child by 6 times. At the same time, the increase is so intense that from 5 months to 5 years of age, the length of the intestine increases by 7-8 times, while its length in an adult exceeds growth by only 5.5 times.

The shape, position and structure of the intestines change with 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 common 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 then 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 old - 23 mm. It distinguishes between 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 the age of 4 years. 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 (jejunum) and the ileum (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 caecum 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 intestine is divided into the following segments:

• (lat. enterum);
• (lat. colon).

Small intestine is a part of the human digestive system located between the stomach and the large intestine. The small intestine is where most of the digestion takes place. The small intestine is called the small intestine because its walls are less thick and strong than the walls of the large intestine, and also because the diameter of its internal lumen, or cavity, is also less than the diameter of the lumen of the large intestine.

The small intestine is divided into the following subdivisions:

• (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 from the food slurry (chyme). The large intestine is called large 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 larger than the diameter of the internal lumen of the small intestine.

The large intestine is divided into the following subdivisions:

• (lat. caecum) with a appendix (lat. appendix vermiformis);
• colon (lat. colon) with its subdivisions:
  • (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 the 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 (intraperitoneally) and have a mesentery, which is a duplication of the peritoneum. Between the sheets of the mesentery are nerves, blood and lymphatic vessels, lymph nodes and fatty tissue.

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

The intestines are 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 sensitive fibers of the spinal and vagus nerves, motor - by sympathetic and parasympathetic nerves.

The walls of the small and large intestines consist of a mucosa, submucosa, muscular and serous membranes. In the intestinal mucosa, the epithelium, lamina propria and muscular lamina are distinguished.

The mucous membrane 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 border epithelial cells, outgrowths of their plasma membrane form many microvilli, due to which the absorptive surface of the small intestine sharply increases. In the mucosal lamina propria there are tubular depressions - crypts, the epithelium of which consists of argentaffinocytes, borderless enterocytes, goblet and Panet cells, producing various ingredients of intestinal juice, incl. mucus, as well as intestinal hormones and other biologically active substances.

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

Physiology of the intestine. The process of digestion in the intestine 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 to polypeptides and disaccharides. Further splitting 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), while an important role belongs to the intestinal enzymes themselves.

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

Various types of intestinal contractions (rhythmic segmentation, pendulum, peristaltic and antiperistaltic contractions) contribute to mixing and rubbing of the intestinal contents, and also ensure its promotion. In the large intestine, water is absorbed, the formation of dense contents and its evacuation from the body. The intestine is directly involved in metabolism. Here, not only the digestion and absorption of nutrients occurs, followed by their entry into the blood, 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, gastroinhibiting polypeptide, vasoactive intestinal peptide, motilin, neurotensin, etc.), which regulate the activity of the digestive system and other body systems. The greatest number of such cells is concentrated in the duodenum. The intestine takes an active part in immune processes. Along with the bone marrow, spleen, lymph nodes, bronchial mucosa, it is a source of immunoglobulins; in the intestine, various subpopulations of T-lymphocytes were also found, 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 mainly by anaerobes.

Methods for examining the intestine. Of great importance in recognizing intestinal diseases is an anamnesis. Identify local (intestinal) and general complaints. Pay attention to the features of the stool (the number and nature of feces, the frequency of defecation, the occurrence of a feeling of relief after defecation, its accompanying phenomena), the presence and nature of abdominal pain, their relationship with stool and food intake, flatulence, rumbling and transfusion in the abdomen. Establish intolerance to a particular food (milk, dairy products, vegetables, etc.), the impact of mental factors (emotional stress, conflicts) and their relationship with the appearance of intestinal disorders. The patient is asked about the daily rhythm of symptoms (for example, night pain, morning diarrhea), with a long process - about their dynamics.

When familiarized with general complaints, it is possible to identify symptoms that occur, for example, in lesions of the small intestine. These include general weakness and weight loss, dry skin, hair loss, increased fragility of nails, menstrual disorders, decreased libido, etc.

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

With the help of superficial palpation, zones of soreness, muscle tension of the anterior abdominal wall are established. The small intestine, with the exception of the terminal ileum, is not palpable. Deep palpation is used to detect pathology of the colon. At the same time, the features of all its departments are consistently determined (shape, size, mobility, soreness, splash noise).

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 a digital examination of the rectum. Of great importance is a coprological study, including macroscopic, microscopic, chemical, bacteriological studies, as well as the determination of helminths and protozoa. Various methods of functional research have been developed to assess the state of the main functions of the intestine. For the study of digestive function, the degree of increase in blood sugar levels after a load of lactose and other disaccharides is established. 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 the determination of an 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 for a certain period of time (usually within 5 hours after its administration), the processes of absorption in the small intestine are judged. Diagnostic value is also the determination of the concentration of D-xylose in the blood.

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 the motor function of the intestine is carried out by registering changes in intra-intestinal pressure and electrical potentials associated with the motor activity of the intestine, using a balloon-kymographic method or using open catheters. Motor activity can also be judged by the rate of movement of the radiopaque substance through the intestines or by the timing of the release of non-absorbable markers with 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 with a thin-walled balloon. When the 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 in the aspirated liquid of the marker and the test substance allows you to determine the intensity of absorption (method of eunoperfusion).

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 performed using radiopaque substances. The former 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 K. with obstruction, etc. A contrast study of the small intestine is usually performed by filling it with a suspension barium sulfate. After 10-15 minutes after ingestion of a radiopaque substance, an image of the first loops of the jejunum appears, and after 1.5-2 hours - of all other parts of the small intestine. In order to accelerate the filling of the small intestine with a radiopaque substance (provided that non-motor function is being studied), the barium suspension is pre-cooled to 4-5 °, and drugs that stimulate the motor function of the intestine are also administered (0.5 mg of prozerin subcutaneously, 20 mg of metoclopramide intravenously). The study of the small intestine is carried out both in the vertical and horizontal position of the patient, along with fluoroscopy, survey and targeted radiography are performed. In a number of cases (for example, for uniform tight filling of the small intestine and its double contrasting), through the probe enterography is used - the introduction of a radiopaque substance using a probe previously inserted through the mouth into the small intestine. The filling of the intestinal loops is carried out under the control of fluoroscopy, the images are taken in different positions of the patient. To relax the bowel 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, you can examine the ileocecal angle, after 24 hours - the large intestine. Filling the colon with a radiopaque substance through the mouth makes it possible to assess mainly its motor-evacuation function, as well as the shape, position, size of the lumen, displacement, and haustration. Transoral examination of the colon is usually used for prolonged persistent constipation or diarrhea, suspected pathology of the ileocecal region, in particular for chronic appendicitis and Crohn's disease. The main X-ray method that allows you to examine the relief of the colon is irrigoscopy. X-ray signs of intestinal damage are changes in its contours, the presence of filling defects, restructuring of the relief of the mucous membrane, disturbances in tone, peristalsis, passage of a radiopaque 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 stool disorders.

diarrhea arise as a result of increased intestinal secretion and a decrease in the absorption function of the intestine. In some forms of pathology, the cause of diarrhea is an increase in the motor activity of the intestine. In case of violations of the functions of the small intestine, a moderate increase in stools (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) are characteristic, as a result of which it smears the toilet bowl. In diseases of the colon, stools are very frequent, but scanty, there may be blood in the feces, but there is no steatorrhea and visible remnants of undigested food.

constipation due to increased motility (non-propulsive peristaltic and antiperistaltic contractions) or a weakening of motor activity of the intestine, followed by coprostasis. Persistent constipation is observed with intestinal atony, which occurs with its chronic diseases, accompanied by damage to the muscular membrane or a violation of neurohumoral regulatory mechanisms. In acute infectious processes, intoxications, neurological disorders, constipation can be observed due to intestinal paresis - an acute violation of intestinal motility.

Pain in the intestines most often associated with an increase in pressure in the small or large intestine, which can be caused by spasm, convulsive contractions of the smooth muscles of the intestine, 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, with ileitis - in the right iliac region, with diseases of the left half of the colon - in the lower abdomen, more often on the left, with diseases of the right half of the colon - in the right iliac region and right lateral sections of the abdomen . The nature of the pain can be different. Pain can be constant or intermittent. With flatulence, they are most often long and monotonous, increase by the end of the day, decrease after stool, gas discharge. Sometimes patients are disturbed by severe cramping pains that occur suddenly in different parts of the abdomen (intestinal colic). Pain can increase during physical exertion, shaky driving, defecation, during an enema, such an increase in pain is observed with mesenteric lymphadenitis, periprocess. For the defeat of the distal colon, tenesmus is characteristic - painful urge to defecate with insufficient or no discharge of the contents. An important sign of damage to the small intestine are syndromes that characterize violations of the functions of the intestine. Digestion insufficiency syndrome is a clinical symptom complex caused by a violation of digestion due to a deficiency (congenital or acquired) of digestive enzymes, more often lactase, less often other disaccharidases. Manifested by diarrhea, nausea, vomiting, polyfaeces and other dyspeptic disorders that occur when consuming dairy products or foods containing other disaccharides. The syndrome of insufficiency of absorption (congenital or acquired) is manifested by a variety of symptoms, which is due to a violation of all types of metabolism. The syndrome of exudative enteropathy (primary or secondary), arising from increased permeability of the intestinal wall, the release of protein from the bloodstream in the intestine and its loss with feces, is characterized by hypoproteinemia, edema, ascites, the appearance of effusion in the pleural cavities, degenerative changes in internal organs. Often, all of these syndromes are observed simultaneously; in these cases, they talk about enteral insufficiency.

Which doctors to contact for examination of the Intestine:

Gastroenterologist

What diseases are associated with the intestines:

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

X-ray of the intestine

CT scan of the intestine

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 emptying of the large intestine. Dolichosigma is manifested by chronic constipation, flatulence, 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 - rectosigmoscopy, colonoscopy, etc. With dolichosigmoid, a diet, massage, exercise therapy, physiotherapy are prescribed; with prolonged constipation - laxatives and enemas. In case of chronic intestinal obstruction, dolichosigmoid resection is performed.

Due to a prolonged lack of bowel movement in a child with dolichosigmoid, fecal stones may form, fecal autointoxication, anemia, and irritable bowel syndrome may develop. One of the formidable complications of dolichosigmoid is intestinal obstruction due to nodulation, volvulus, kinks, invagination 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 a lack of body weight, a lag in physical development, and pallor of the skin. On palpation of the abdominal cavity, intestinal loops overflowing with fecal masses are determined. A digital rectal examination reveals an empty rectum, even if the child has not had a stool for a long time.

The decisive instrumental method in the diagnosis of dolichosigma is irrigography, during which the elongation of the sigmoid colon, the presence of additional loops in the form of a "eight", "shotgun", "knot", "cochlea", etc. are detected. , shape, contours, length, lumen width, haustration, the presence of additional loops.

To assess the motor-evacuation function of the colon in a patient with dolichosigmoid, barium passage radiography, electromyography, and sphincterometry are performed. Endoscopy in children (rectosigmoscopy, colonoscopy), ultrasonography of the large intestine, ultrasound of the abdominal cavity, plain radiography of the abdominal cavity in the diagnosis of dolichosigmoid are of auxiliary importance. Of the laboratory methods, a coprogram is used; analysis of feces for dysbacteriosis, for occult blood, for 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. To this end, the child should be consulted by a pediatric gastroenterologist, pediatric coloproctologist, 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 with the help of a diet - fractional nutrition, the use 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 microclysters, however, with dolichosigmoid it is extremely important to form a reflex to spontaneous defecation.

With spastic pains, antispasmodics are prescribed (drotaverine, platifillin); with intestinal hypotension - prozerin, massage of the anterior abdominal wall, exercise therapy, electrical stimulation of the colon, hydrocolonotherapy, acupuncture. Patients with dolichosigma benefit from courses of vitamin therapy (B6, B12, C, E), bacterial preparations (probiotics and prebiotics), treatment in the sanatoriums of Zheleznovodsk, 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 unresolved loops and bowel kinks. With dolichosigma, resection of the sigmoid colon is performed. In the case of a predominant lesion of the distal sigmoid colon, the operation of choice is proctosigmoidectomy.

Forecast

Usually, with the implementation of all medical recommendations, it is possible to achieve regular independent stools and an acceptable quality of life. As the child grows, many violations can be compensated; in some cases, the problem of dolichosigma worries patients in adulthood. In the latter case, life-long observance of the regimen and quality of nutrition, the exclusion of the development of alimentary, psychogenic and other types of constipation are necessary. Children with dolichosigma need to be observed by a pediatrician, a pediatric gastroenterologist, undergo periodic courses of conservative therapy, and examine 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. In 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 a variant of the norm. If it is accompanied by prolonged constipation, flatulence, recurrent abdominal pain, then pathologies are already called and require adequate treatment. Many people have not heard much about this rare disease, although its destructive effect 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 in the colon, causing its excessive mobility, resulting in serious problems 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. Causes: 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 due to a number of factors, among which the most significant are:

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

The reasons for the acquired form of the elongated sigma are:

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

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

• Mucosal dystrophy.
• Growth of muscle tissue.
• Violations 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 belongs to vices or is considered the norm.

Symptoms

Among the main signs of the disease are:

• Prolonged constipation, the number of which increases over time. There may not be a chair for a week, and sometimes for a month.
• Stagnation of feces leads to poisoning of the body.
• Pain with difficult localization. Intensifies over time.
• Flatulence.
• Bloating.
• Appetite problems.

Accurate diagnosis

It begins with an examination of the patient by a doctor who collects data on complaints, operations and past diseases. Thanks to the analysis of a family history, the specialist determines the genetic predisposition to anomalies in the structure of the sigma. The doctor performs palpation of the abdomen, in the presence of pathology reveals pain in the region to the left of the navel.

Methods of laboratory diagnostics make it possible to assess the composition of blood and feces, by which it is already possible to judge the presence of inflammatory processes, the level of hemoglobin, and the concentration of basic microelements.

Of the instrumental diagnostic methods are assigned:

• Sigmoidoscopy with visualization of the mucosa 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 showing 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. Helps enemas and drugs with a laxative effect.
• Decompensated, which is characterized by delayed bowel movements up to a week, bloating, accompanied by constant severe pain. The consequence of poisoning the body are skin lesions with the appearance of pustules, nausea, lack of appetite. Relief comes after siphon enema.

Ignoring the problem can lead to complications, including:

• Irritable bowel syndrome, accompanied by discomfort in the abdomen, flatulence and other functional digestive disorders.
• Eruptions on the skin.
• Anemia.
• Weight loss.
• Problems with intestinal permeability.
• Cracks in the walls of the stomach and bleeding.
• The formation of dense dry fecal stones from stagnant feces, which makes it difficult to defecate on your own.
• Poisoning of the body with toxic products of decay due to their reabsorption into the blood.

Treatment of intestinal dolichosigma

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

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. In case of hypotension of the digestive canal, the doctor prescribes: Prozerin in a course of 2-3 weeks, taking vitamins B6, B12, E and C, reflexology, electrical stimulation of the large intestine (consisting of 15 procedures, which are carried out one every day).

If necessary, treatment in adults is carried out using hypnotics and sedatives, as well as antispasmodics (No-shpa and Platifillin), defoamers, pre- and probiotics, prokinetics, saline laxatives to increase the volume of feces.

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 homemade recipes, but only after the approval of the doctor. To get rid of constipation prepare:

• A decoction of 250 ml of water and 2 tbsp. l. buckthorn fruits. After 2 hours of infusion, drink a third of a glass before going to bed. Leads to a healthy morning bowel movement.
• Cabbage juice to take 0.5 tbsp. within 3 weeks.
• A mixture of yarrow, cumin, buckthorn and watch (2:1:5:2). Pour one tablespoon of herbal collection with a glass of boiling water, after insisting and filtering, divide the resulting volume by 3-4 times.
• Remedy from 250 ml of boiling water and 1 tbsp. l. raisins. Insist hour. Can be given to a child.

Exercises

With a diagnosis of intestinal dolichosigma, professional sports and intense physical activity are contraindicated, but walking, not very long runs, swimming, morning exercises and special exercises are useful. They normalize bowel function and improve the general condition of a person.

In the morning, without getting out of bed, you can perform a complex of physiotherapy exercises from the following exercises:

• Sitting on the edge of the sofa, raise your hands, your left leg too, while lowering your right leg and strive with the movements of the body so that the limbs 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. The legs are bent at the knees and raised at a right angle. Perform knee turns in one direction or the other.
• Hold on to the headboard with your hands. Rotate the feet, while keeping the legs straight and closed.
• The starting position is the same. The left leg is placed on the right, with the foot down, trying to get the bed.

The problem with prolonged constipation is eliminated by doing regular squats daily.

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

Operation

Surgical intervention is prescribed in the case of complicated dolichosigma, which is not amenable to drug therapy, and its symptoms affect the patient's labor 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 prolonged and persistent constipation, a sharp weakening of reflexes in response to mechanical stimuli, expansion of the sigma, persistent damage to the muscular apparatus and nervous regulation. The endoscopic detorsion method is used in case of torsion of the sigma.

Diet for sickness

Nutritional modification is part of the treatment for uncomplicated dolichosigma. The patient's condition improves with the observance of the water-salt regime and the use of foods high in fiber: honey, fruits, kvass, rye bread and raw vegetables. The diet should include potato dishes instead of flour products.

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

Normal stool in a child of different ages.

From the first days of life, the baby's digestive system begins to work. By the quantity and quality of bowel movements, one can judge the work of the gastrointestinal tract. Immediately after birth, the baby's stool is 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 child poops several times, but at least 1 time per day. And if the feces are not tight, but of the same consistency, have a yellow or yellowish-brown color and a sour smell, there is no reason for concern. After the introduction of complementary foods from 4–5 months, the stools have an unpleasant odor, resemble putty, and the color becomes brown with dark patches. The normal frequency of stools in a child is 4 to 10 times a day. Although now doctors are of the opinion that if a child up to 4-6 months old poops once every 2-3 days with a mushy mass without a putrid odor, but at the same time the baby is active, there are no symptoms of anxiety, his tummy is soft, which means that his digestive system is working Fine.

Up to one and a half years, the feces have a mushy consistency, up to two years it can be different, and after - the feces should be formalized. However, it is necessary to monitor the child'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. It is not uncommon for parents to see a doctor about a child's lack of bowel movements for some time.

Constipation in a child. Causes.

Constipation is considered 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 defecation, and then is completely afraid to walk “in a big way”. It is always necessary to check the consistency of feces. If you notice that the bowel movements have become smaller, and they have a “large diameter” and a dense consistency, or are divided into small peas and with 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 apparatus and dysregulation of the intestines. These constipations occur for the following reasons:

• malnutrition of a nursing mother;
• insufficient water intake by the child;
• incorrect transfer to artificial feeding;
• irrational nutrition of children of 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;
• the use of certain drugs;
• the presence of worms in children.

With proper nutrition, normalization of the water-food regimen and elimination of the main diseases that cause constipation, the act of defecation is normalized.

Organic constipation is associated with a defect or underdevelopment 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 adverse factors on the development of the child during pregnancy: drugs, chemical poisoning, poor ecology, radiation, sunbathing abuse, viral infections, especially if the pregnant mother had rubella after 20 weeks. The diagnosis of dolichosigma can be made if the pain syndrome and severe stool disorders in the form of constipation are expressed.

The sigmoid colon is a section of the large intestine that is located in the small 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 it is 25–30 cm, and at 10 years old it is 37–38 cm. The continuation of this section is the rectum.

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

When the famous Ilya Ilyich Mechnikov was awarded the Nobel Prize for his proposal to give patients with intestinal dysfunction ordinary yogurt to drink, the poet Alexander Blok presented the scientist with his poems with the inscription: “Is it not possible to measure all our longing with the 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 whole life without suspecting his defect. But dolichosigma is most often manifested by constipation, which bothers children from the first days of life. However, the diagnosis can only be made at 2-3 years of age, since constipation after birth is regarded as an error in the transfer to artificial feeding or with improper introduction of complementary foods.

At first, constipation is rare, then it becomes more frequent and more painful and becomes permanent. The child complains of constant pain in the abdomen, as well as during the act of defecation. The pains intensify after a heavy lunch or dinner and almost stop after a pot. On palpation of 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 with streaks of blood (if the intestinal mucosa is damaged). Dolichosigma is confirmed after irrigoscopy or radiographically. 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 in the course of the disease:

• Compensated. Constipation worries. Properly selected diet and taking mild laxatives normalizes the condition.
• Subcompensated. Constipation bothers more often, does not go away after taking laxatives. Cleansing enemas required. There are signs of intoxication: nausea, dry skin, headache, subfebrile temperature (37.1-37.5°C).
• Decompensated. Constant constipation. Pronounced intoxication of the body with nausea, vomiting, lack of appetite, anemia, weakness. Helps only.

A few words about enemas

Enemas are not an option! With frequent use of enemas, the large intestine becomes "lazy", that is, it does not respond to nerve impulses, peristalsis stops. It is problematic to "start" such an intestine. Along with this, dysbacteriosis and beriberi develop due to the washing out of normal microflora and nutrients.

Treatment

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

Be sure 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 desirable to give vegetables in the form of mashed potatoes, exclude fatty, fried, smoked foods. Recommended: rye or bran bread, fresh low-fat dairy products, decoctions of dried fruits, prunes. It is better to cook porridge from whole grains - wheat, buckwheat, oatmeal. It is recommended to give the child 10 g of olive oil and two tablespoons of bran daily.

Dolichosigma is also treated with daily morning exercises with exercises for the abdominal muscles, a massage of the anterior abdominal wall is necessary. From physiotherapy, applications from paraffin and ozocerite, warm, wet wraps, novocaine blockades, electrical stimulation of the intestines, and acupuncture are prescribed.

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

Usually, proper nutrition and adherence to the recommendations of the doctor allows you to achieve improvements in the condition of the child, eliminate constipation. In most cases, with the growth and development of the child, all symptoms are compensated. There are times when constipation remains for life. In this case, only proper nutrition and a “fight” with constipation are required.

The question of surgery is raised extremely rarely and only in such cases: the failure of conservative treatment, increasing intoxication, intestinal obstruction or intussusception (insertion of one part of the intestine into another - like a screwed 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 observed by a pediatrician and a pediatric gastroenterologist. Moms ask the question if dolichosigma can go away with age. The answer is unequivocal - NO, dolichosigma is an anatomical feature. This is destined to last a lifetime. But the symptoms of constipation can decrease if the right diet is selected and the motor mode is established.

Health to you and your children!

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

I was going to write a review about a new type of surgical operations on the intestines, but I thought that first I need to tell about structure this same intestine. When I was in school, I sometimes confused which gut goes for which. Therefore, today we are eliminating this gap. You even know which gut was named hungry and why.

Will a short course in anatomy, get ready. Unnecessary thrown out, 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 at the beginning is 4-6 cm and gradually decreases up to 2.5-3 cm. The large intestine has average diameter 4-10 cm. In appearance, even a student with a poor student will distinguish them, but more on that below.

SECTIONS 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: textbooks contain different numbers about the length of the small intestine. The solution is simple: alive The length of the human small intestine is 3.5 - 4 meters, A at the dead - about 6-8 m due to loss of bowel tone, that is, 2 times more. Large intestine length much less - 1.5 - 2 meters.

Small intestine

The small intestine has 3 departments:

1. duodenum 12(lat. duodenum, read "duodenum", stress everywhere on the penultimate syllable, if I did not highlight 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, they flow into it common bile duct And main pancreatic duct(sometimes there is an additional pancreatic duct). The name is given according to the length of this intestine, which ancient anatomists measured on the fingers(linear was not used). The finger in ancient times in Rus' was called finger("index finger").
2. jejunum(jejunum, jejunum - empty, hungry): represents upper half small intestine. You didn’t have a question why the gut was called “ hungry"? Just at the autopsy, it often turned out to be empty.
3. ileum(ileum, Ileum - from the Greek ileos to twist): is lower half small intestine. There is no clear boundary between the jejunum and the ileum, and they themselves are very similar in appearance. Therefore, anatomists agreed that the upper 2/5 of the small intestine is jejunum, A lower 3/5 - ileum. Calculate the length in meters yourself.

SECTIONS OF THE SMALL INTESTINE in Latin.
Duodenum- 12-ringed intestine.
Jejunum- skinny intestine.
Ileum- iliac intestine.

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

Typical microscopic structure of the intestinal wall is (from the inside to the outside):

• mucous membrane,
• submucosa,
• muscle layer:
• internal circular (circular),
• outer longitudinal (only three ribbons remain from it in the large intestine, 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) - submucosal,
muscularis (muscularis) - muscle layer(inner - inner, outer - outer),
serosa (serosa) - serosa(here is the peritoneum),
messery- mesentery.

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

Colon

Let's move on to large intestine. One of my favorite anatomy questions is to name the external difference between large intestine and 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 is left of the longitudinal muscle layer of the wall),
4. Availability swelling(protrusions of the wall) - gaustr (haustrum),
5. Availability omental processes(fat supplements).

FEATURES OF THE LARGE INTESTINE
(clockwise from its start)
Ileum - ileum
Vermiform appendix - appendix (appendix),
Cecum - caecum
Ileocecal valve - ileocecal valve,
Superior mesenteric artery - superior mesenteric artery,
Haustrum- haustra,
Right colic flexure - right colon bend,
Transverse mesocolon - mesentery of the transverse colon,
Left colic flexure - left colic bend,
epiploic appendages- fat supplements,
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, cecum): length 1 - 13 cm; This is the section of the large intestine below the confluence of the ileum, that is, below the ileocecal valve. A appendix (appendix) departs from the convergence of the three ribbons, which can be directed not only downward, but also in any other direction.
2. ascending colon(colon ascendens, colon ascendance)
3. transverse colon(colon transversum, colon transversum)
4. descending colon(colon descendens, colon descendens)
5. sigmoid colon(colon sigmoideum, colon sigmoideum): the 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.

SECTIONS 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 told the structure of the intestines in a simplified form. Students learn in more detail: how they are covered with a 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 commonly used paraproctitis- inflammation of the tissue around the rectum (a couple - about).

Update as of February 29, 2008. Inflammation of the caecum is called typhlitis(from the Greek typhlon - caecum). You are unlikely to need a name, but added here for encyclopedic presentation.

What is interesting: the small and large intestines differ not only in structure and function. They get sick differently. Diarrhea (diarrhea) with enteritis sharp in appearance different from diarrhea in colitis. But more about that some other time. If there are people who want to read. 🙂

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

Enemas will not work. 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 that will not allow the reverse flow of the intestinal contents.

Thank you doctor for the quick answer!! The tests haven’t shown anything yet, I’ll hand it over in another 2 weeks, and from the pinworms that I saw in children, we drank it 3 times already, there are definitely no pinworms, and my perineum itches in the evenings, so I think maybe someone else got there! 😥 But I don’t want to wait until they breed!! I can’t even think of such a thing!! Thank you again, doctor!!

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

You write as if the problems started after you found an extra loop of intestines. In fact, they appeared much earlier, because of which you had to do barium enema. Need to investigate further. More informative colonoscopy.

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