Huge colon

Introduction Congenital megacolon is a false name because megacolon changes are not congenital. Because there is no ganglion cells in the distal intestinal wall of the megacolon, it is in a state of stenosis, loss of peristalsis and defecation function, resulting in proximal colonic stagnation and accumulation of gas, while continued expansion, hypertrophy, and gradually formed a megacolon change. Have a genetic predisposition. The basic pathological change of Hirschsprung's disease is the lack of ganglion cells in the intermuscular and submucosal plexus of the intestinal wall. The number of non-myelinating parasympathetic nerve fibers increases and becomes thicker. Therefore, the congenital megacolon is also called "none." Aganglionosis.

Cause

The basic pathological change of Hirschsprung's disease is the lack of ganglion cells in the intermuscular and submucosal plexus of the intestinal wall. The number of non-myelinating parasympathetic nerve fibers increases and becomes thicker. Therefore, the congenital megacolon is also called "none." "Aganglionosis", due to the absence and reduction of ganglion cells, causes the diseased intestine to lose the propulsive normal peristalsis, often in a paralyzed state, forming a functional intestinal obstruction, difficulty in passing the feces, and the proximal end of the gut tube due to long-term The septic deposits gradually expand and become thick and form a megacolon.

an examination

Related inspection

Sigmoidoscopy gastrointestinal CT examination colonography

Diagnosis of congenital megacolon, mainly based on clinical manifestations, confirmed X-ray barium enema, rectal anal canal pressure, rectal biopsy, histochemistry and other objective examination methods.

Differential diagnosis

In children with congenital megacolon, acute bowel obstruction occurs in the neonatal period, and it is not uncommon to open an expansive laparotomy; in the elderly, misdiagnosis of fecal stone as a tumor is also occurring; it is often delayed due to atypical symptoms. Diagnosis and treatment. The reasons for misdiagnosis and mistreatment are mainly due to unclear medical history and inconspicuous examination. Secondly, there is a lack of understanding and understanding of congenital megacolon. Congenital megacolon must be differentiated from the following conditions.

(1) Congenital anorectal malformation: This disease is the most common cause of low intestinal obstruction. When the anus is locked or only the pupil is seen, the abnormal anus can be identified by careful observation, but the normal rectal stenosis or atresia of the anus is also confirmed by anal examination and X-ray examination.

(2) Congenital intestinal atresia or stenosis: low intestinal atresia or stenosis is also a manifestation of low intestinal obstruction. There is no fetus after the anus examination or only a small amount of gray-white jelly-like stool (intestinal stenosis may have a small amount of feces). X-ray barium enema shows that the distal colon of the lesion is abnormally small (fetal colon), and the expectorant cannot pass through the lesion (latching) or difficult to pass (stenosis) the lesion.

(3) Functional intestinal obstruction: functional intestinal obstruction is common in premature infants, Nixon et al (1968) by rectal anal canal pressure test for such children, proved lack of normal reflex, thought to be related to immature cells of intermuscular ganglion cells . Other diseases can also cause functional intestinal obstruction in newborns, such as dyspnea, infection, and brain tissue damage.

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