On the diagnostics and treatment of chronic constipation
O.Yu. KARPUKHIN1,2, A.F. SHAKUROV2, N.Yu. SAVUSHKINA1, E.V. MOZHANOV1,2, S.N. KOLOMENSKIY1, A.A. GILMUTDINOV1, E.V. CHERENKOV1, R.R. ZARIPOV1, A.A. ELEYEV2
1Republican Clinical Hospital of the Ministry of Healthcare of the Republic of Tatarstan, 138 Orenburgskiy Trakt, Kazan, Russian Federation 420068
2Kazan State Medical University, 49 Butlerov St., Kazan, Russian Federation 420012
Karpuknin O.Y. — D. Med. Sc., Professor of the Department of Surgical Diseases № 1, tel. (843) 269-00-53, e-mail: oleg_karpukhin@mail.ru1,2
Shakurov A.F. — postgraduate student of the Department of Surgical Diseases № 1, tel. +7-904-660-11-39, e-mail: aydarsha@yandex.ru2
Savushkina N.Yu. — Cand. Med. Sc., doctor of Ultrasonic Diagnostics Department, tel. (843) 237-34-86, e-mail: oleg_karpukhin@mail.ru1
Mozhanov E.V. — D. Med. Sc., Assistant Lecturer of the Department of Surgical Diseases № 1, doctor of Coloproctology Department, tel. (843) 269-00-53, e-mail: e.mozhanov@gmail.com1,2
Kolomenskiy S.N. — Head of Coloproctology Department, tel. (843) 269-00-53, e-mail: sergey-kolomenskiy@yandex.ru1
Gilmutdinov A.A. — doctor of Coloproctology Department, tel. (843) 269-00-53, e-mail: anasgilm@mail.ru1
Cherenkov E.V. — doctor of Coloproctology Department, tel. (843) 269-00-53, e-mail: evgen.63@mail.ru1
Zaripov R.R. — doctor of Coloproctology Department, tel. (843) 269-00-53, e-mail: zrland@rambler.ru1
Eleyev A.A. — postgraduate student of the Department of Surgical Diseases № 1, tel. (843) 269-00-53, e-mail: alim1425@mail.ru2
The results of treatment of 540 patients with chronic constipation of nonneoplastic genesis are analysed. The diagnostic and treatment algorithm for patients with chronic constipation is presented. The proposed algorithm of diagnostics allows to establish anomalies in the structure and location of the colon, to assess its functional state, to carry out differential diagnostics with Hirschsprung’s disease.
The effect of conservative therapy was observed in 458 (84,8%) patients, ad it is noted that chronic constipation in patients with normal architectonics of colon has a benign clinical course. 82 (15,2%) patients with chronic constipation as a consequence of various anomalies of structure and fixation of colon in the abdominal cavity were operated. A choice of intervention depended on the causes of constipatin syndrome established during complex examination and also were based on the functional conditions of the intestine. The analysis of the long-term results for the period from 9 months to 15 years shows that surgery of chronic constipation can be effective if patients are carefully selected and balanced approach is applied whenchoosing the surgical intervention volume.
Key words: chronic constipation, diagnosis, surgical treatment, long-term results.
REFERENCES
1. Samsonov A.A. Syndrome chronic seizure. Russkiy meditsinskiy zhurnal, 2009, vol. 17, no. 4, pp. 233-237 (in Russ.).
2. Wexner S.D., Duthie G.D. Constipation. Etiology, evaluation and management. Second edition – Springer, 2006. 265 p.
3. Achkasov S.I., Zhuchenko A.P., Kapuller L.L., Podmarenkova L.F. Results of subtotal resection of the colon in patients with chronic colonic stasis. Aktual’nye voprosy koloproktologii, 2003, pp. 413-414 (in Russ.).
4. Dzhavadov E.A. Khirurgicheskoe lechenie bol’nykh s khronicheskim kolostazom na fone dolikhokolon: avtoref. dis. … d.m.n. [Surgical treatment of patients with chronic kolostaza on background dolichocolon. Synopsis of dis. Dr med. Sci.]. Moscow: RUDN, 2011.
5. Zinkevich O.D., Anikhovskaya I.A., Safina N.A. et al. Sposob opredeleniya aktivnosti endotoksina (varianty). Patent № 2169367 ot 16.08.2000 [A method for determining endotoxin activity (options). Patent number 2169367 from 16.08.2000.].
6. Khavkin A.I. Funktsional’nye narusheniya zheludochno-kishechnogo trakta u detey rannego vozrasta [Functional disorders of the gastrointestinal tract in infants]. Moscow, 2000. 72 p.
7. Fedorov V.D., Dul’tsev Yu.V. Proktologiya [Proctology]. Moscow: Meditsina, 1984. 384 p.
8. Tabolin V.A., Yakovlev M.Yu., Il’ina A.Ya. et al. The pathogenetic mechanisms and clinical aspects of the action of a thermostable endotoxin intestinal microflora (review). Russkiy meditsinskiy zhurnal, 2003, no. 3, pp. 126-129 (in Russ.).