Constipation with an enlarged colon - constipation, differential diagnosis. Toxic dilatation of the colon Why did the lymph nodes in the intestine become inflamed

Complications of nonspecific ulcerative colitis are extremely diverse. They can mean both severe conditions that have arisen as a result of intestinal damage, and various systemic diseases that develop against the background of autoimmune aggression.

In this article, we talk about the first group of negative consequences of NUC. They deserve special attention, because. many of them pose a serious risk to life.

Dangerous consequences of ulcerative colitis

If the complication is detected at an early stage, the chances of a successful elimination of the problem will increase significantly. Each patient with a diagnosis of UC needs to know, at least in general terms, what are:

• toxic megacolon;
• perforation (perforation) of the intestine;
• massive bleeding;
• colon strictures;
• malignant degeneration of ulcers.

Development of toxic megacolon

This concept refers to toxic dilatation of the colon. Against the background of a significant violation of neuromuscular regulation, the tone of its walls may fall, because of this, pressure in the lumen increases. A similar effect sometimes gives a strong narrowing of the lower sections of the large intestine and the intake of certain drugs.

Toxic megacolon develops in 3-5% of patients with total UC (pancolitis). In about 20% of cases, the process is fatal.

This complication is manifested by a significant deterioration in the patient's condition - a temperature of 38 degrees, intense abdominal pain, signs of intoxication of the body and encephalopathy (lethargy, confusion).

Perforation in UC

Perforation means rupture of the intestinal wall with the release of the contents of the lower gastrointestinal tract - by default bacterial - into the abdominal cavity. At the same time, peritonitis, an acute inflammation of the peritoneum, begins very quickly. It is possible to save a person only under the condition of emergency and competent medical care.

Most often, perforation is the result of the toxic megacolon mentioned above.

The characteristic features of perforation are excruciating pain in the abdomen, a rapid increase in heart rate, and a noticeable tension in the muscles of the anterior abdominal wall.

Massive bleeding in ulcerative colitis

Patients with UC often find an admixture of blood in the feces. Sometimes it is also separated with tenesmus, false urge to defecate. Most often, one-time blood loss is small, but in 1% of patients it reaches a critical volume of 300 ml. per day.

The process is accompanied by symptoms posthemorrhagic anemia- lack of iron-containing elements in the plasma. Shortness of breath begins, the heartbeat quickens, the skin turns pale. The patient feels dry mouth, it darkens before his eyes. Vomiting is also possible. Depending on the severity of the condition, the patient is given iron supplements or a blood transfusion.

Attention: sometimes increased bleeding in UC indicates toxic megacolon.

Strictures in the large intestine

Stricture is narrowing of the organ, which has a tubular structure. The formation of intestinal narrowing is most likely in those people who have UC for a significant period. It is caused by thickening of the walls, outflow of the submucosal layer, fibrosis.

According to the symptoms, the phenomenon resembles intestinal obstruction. There is a severe general state of health, pain and seething in the abdomen, an obvious retention of stools and gases, asymmetric bloating.

The presence of a stricture can be reliably established through colonoscopy and irrigoscopy.

Bowel cancer - the first manifestations

colorectal cancer is a very common continuation of non-specific ulcerative colitis. The longer the "experience" of life with NIBD, the higher the risk of oncological consequences.

If, with a 5-year duration of NUC, malignant degeneration of ulcers occurs in 2-3% of cases, then with the course of the disease for more than 25 years, cancer affects the intestines of 42% of patients. Patients with pancolitis, a total intestinal lesion, are especially susceptible to this complication.

It is difficult to assume the formation of a tumor based on some external symptoms - cancer does not make itself felt immediately, and even at the later stages, its individual manifestations can be easily attributed to the overall clinical picture of UC.

To avoid a tragedy, it is necessary to regularly, at least once every three years, undergo a control endoscopic examination with a biopsy.

Complications of NUC are divided into local and general (systemic). Local include perforation, toxic dilatation (toxic megacolon), intestinal bleeding, rectal or colonic strictures, fistulas, perianal skin irritation, and colon cancer.

Systemic complications are associated with extraintestinal manifestations of ulcerative colitis.

You can read about the causes, diagnosis and types of ulcerative colitis in the article.
Read about the methods of treating NUC.

Perforation of the intestinal wall occurs when it expands, thinning. The opening is usually located in the sigmoid colon or in the region of the splenic flexure.

More often perforations are multiple and penetrate into the abdominal cavity, less often they are single and covered. With the first occurrence of ulcerative colitis, the frequency of perforation does not exceed 4%. Severe, long-term UC is complicated by perforation in about 10% of cases.

Diagnosis of this complication is rather difficult, since it causes a serious condition of the patient, and it is not always possible to obtain information from him about the symptoms that disturb him. The results of physical examination are also insufficiently informative (perforation is characterized by symptoms of peritoneal irritation).

An X-ray examination, in which free gas is found in the abdominal region, helps to establish the diagnosis of intestinal perforation.

Toxic dilatation (toxic megacolon) of the colon

This is a severe complication of UC, which develops in 5-10% of cases.

Lead to the development of toxic dilatation

• damage to the intestinal tract,
• inflammatory damage to the smooth muscles of the intestinal wall,
• hypokalemia with impaired muscle tone,
• (, shigellosis, etc.),
• ulceration,
• toxemia,
• diagnostic manipulations (X-ray examination, colonoscopy),
• irrational drug therapy (prescription of opioid drugs, anticholinergics).

Some researchers note the influence of steroid therapy, cholinergics on the development of this syndrome.

Toxic megacolon is a paralysis of the smooth muscle of the intestine that develops due to a severe inflammatory process. It often results from the inadvertent prescription of drugs that reduce intestinal motility (codeine, loperamide, anticholinergics and other drugs) for the treatment of diarrhea in acute ulcerative colitis, which can provoke toxic distension of the colon.

In the same way as the use of laxatives in the presence of constipation in patients with UC, especially against the background of hypokalemia, may be the cause of signs of toxic megacolon.

Toxic colonic megacolon manifests itself

• a sharp deterioration in the patient's condition,
• an increase in toxicity
• inhibition of reactions
• an increase in body temperature over 38.8⁰С,
• decrease in stool frequency
• enlargement of the abdomen
• weakening of peristaltic intestinal noises,
• flatulence,
• slight tension in the muscles of the anterior abdominal wall,
• tachycardia more than 120 beats / min.,
• leukocytosis over 10.6x10⁹/l,
• anemia.

The most important method in the diagnosis of this complication is a survey X-ray examination of the abdominal wall. It is performed with the patient in the supine position. A characteristic radiological sign of this complication is a significant expansion of the colon from 5 to 16 cm, an average of 9 cm.

As a rule, the transverse colon is subject to the greatest expansion. And in about 50% of cases, it is eliminated by surgery. The rectum does not expand.

The prognosis for this complication is very serious, especially with the simultaneous occurrence of toxic dilatation and perforation of the colon.

Conservative therapy for toxic megacolon is usually given within 24 hours.

Cancel all drugs administered orally (by mouth).

The task of conservative therapy is the correction of water and electrolyte balance, protein deficiency and anemia. Be sure to prescribe antibiotics, glucocorticoids in shock doses. It is necessary to constantly monitor the patient's condition. Mandatory control of diuresis. It is important to conduct ultrasound and x-ray control of the condition of the dilated colon.

If a patient with severe ulcerative colitis fails to achieve positive dynamics within 2-3 days, then an urgent surgical operation is indicated for him.

Intestinal bleeding

Bleeding as a complication of UC must be distinguished from the discharge of scarlet blood with feces in the normal course of ulcerative colitis.

With this complication, blood from the anus is released in clots. Massive bleeding in ulcerative colitis develops in no more than 1% of patients. The causes of intestinal bleeding may be the growth of granulation tissue at the bottom of the ulcer, vasculitis of the bottom and edges of ulcers.

These changes are accompanied by necrosis of the vascular wall, phlebitis, leading to a sharp narrowing of the veins of the mucous, submucosal and muscular membranes of the intestine, expansion of their lumen with the formation of vessels resembling wide gaps or cavernous type vessels, which undergo rupture and give massive bleeding.

Surgical treatment is necessary for a patient with intestinal bleeding in the event that the stabilization of the patient's condition requires the introduction of blood in a volume exceeding 3000 ml within 24 hours.

Strictures of the rectum or colon

Found in approximately 10% of patients with ulcerative colitis. In a third of patients, the obstruction is localized in the rectum. In the presence of colon strictures, there is always a need for a differential diagnosis with colon cancer or.

Inflammatory colon polyps

Polyps are diagnosed with and X-ray examination. A characteristic sign of this complication, which is detected during irrigoscopy, is the presence of multiple filling defects along the intestinal wall. The diagnosis of pseudopolyposis is confirmed histologically.

Systemic complications

Systemic complications are those that affect various systems and organs of a person. They occur in a significant proportion of patients with severe UC. Most complications are of an autoimmune nature and are an indicator of the activity of the pathological process. These complications of ulcerative colitis are divided into two groups: associated with colitis and not dependent on it.

Extraintestinal complications of UC

In ulcerative colitis, both intestinal and extraintestinal diseases can occur. You need to be aware of possible symptoms that at first glance are not related to the intestines. This will allow you to be alert, get tested and diagnose serious intestinal inflammation as early as possible.

Such manifestations of the disease occur in 30% of patients suffering from UC. There is a certain relationship between extraintestinal manifestations, the extent of colon damage and the severity of the disease.

Damage to the organ of vision

Eye diseases occur in 13-30% of cases.

Possible diseases:

• episcleritis;
• uveitis;
• retrobulbar neuritis;
• iridocyclitis;
• keratitis;
• retinal arteritis obliterans.

Of these diseases, uveitis is the most common. Moreover, often eye symptoms are determined many years before the onset of intestinal symptoms of nonspecific ulcerative colitis.

Exacerbation of eye diseases develops against the background of severe exacerbations of ulcerative colitis and can even lead to blindness. Moreover, eye pathology can persist during periods of remission of the underlying disease.

Eye damage symptoms:

• prolonged redness of the eye;
• pupil deformity;
• the appearance of "flies" before the eyes,
• deterioration in visual acuity,
• the appearance of flashes and flickering before the eyes,
• the shape of objects is distorted,
• vision blurs,
• reading difficulties,
• deterioration of twilight vision, impaired color perception.

Skin manifestations and lesions of the oral mucosa

These complications occur in 15% of people with ulcerative colitis and their course is directly related to exacerbations of this disease.

This type of complication is manifested by the following diseases:

• necrotic pyoderma;
• aphthous stomatitis;
• gingivitis;
• ulceration of the lower extremities (erythema multiforme);
• psoriasis.

Stomatitis

Oral mucosal lesions are more common in patients with

• with anemia
• with a lack of body weight,
• with avitaminosis.

This disease is relatively common in UC. The progression of the disease can lead to the development of gangrenous stomatitis.

erythema nodosum

This complication is often associated with arthritis (chronic inflammation of the joints) and is often the first manifestation of ulcerative colitis.

Erythema nodosum manifests itself with symptoms such as:

• the appearance of dense nodes of different diameters from 5 mm to 5 cm,
• over the nodes the skin is red and smooth,
• the nodes rise slightly above the general skin, but there are no clear boundaries,
• tissues around the nodes swell,
• nodes grow very fast, but once they reach a certain size, they stop growing,
• pain on palpation
• after 3-5 days, the nodes change color, the skin becomes brownish, then turns blue and gradually turns yellow,
• nodes often appear on the anterior surface of the legs,
• most often the disease begins acutely, with fever.

Pyoderma gangrenosum

The skin is affected against the background of a severe course of the disease, most often on the legs and in the sternum. The appearance of this complication allows us to draw conclusions about the development of sepsis (blood poisoning).

Other skin complications

Recently, complications of NUC have been described, such as

• focal dermatitis,
• boils,
• superficial skin abscesses,
• skin ulceration,
• skin rashes (macular, papular, pustular, urticarial).

Joint and spinal injuries

These complications occur in 20-60% of patients with ulcerative colitis. They appear more often in the chronic form of the disease.

Diagnoses that may be due to ulcerative colitis:

• osteopathy;
• peripheral arthritis;
• ankylosing spondylitis;
• arthralgia;
• sacroiliitis.

Joint pain

Arthritis (joint disease) is equally common in both adults and children, both men and women. With ulcerative colitis, the joints of the upper limbs and small joints are more often affected, with Crohn's disease - the knee and ankle joints.

This complication occurs, as a rule, with a significant lesion of the colon. Exacerbations of the disease in 60-70% of cases are associated with exacerbations of UC.

The main symptoms are:

• swelling of the joints;
• soreness;
• redness of the skin over the joints;
• effusion into the synovial cavity.

With each exacerbation, as a rule, no more than three joints are affected. Moreover, different joints can suffer from attack to attack.

Backache

Ankylosing spondylitis is often associated with peripheral arthritis, uveitis, and psoriasis.

The main symptoms of spondylitis are:

• backache;
• stiffness of the spine;
• improvement in movement and exercise.

The disease can progress even with remission of ulcerative colitis and often leads to disability.

Liver damage

Often ulcerative colitis is accompanied by diseases such as:

• fatty hepatosis of the liver;
• liver abscess;
• gallbladder stones;
• sclerosing cholangitis.

Fatty liver disease

The frequency of fatty hepatosis of the liver ranks first. The process does not progress and there is no tendency to transform it into cirrhosis of the liver. Strict adherence to diet, normalization of body weight, normal content of protein, vitamins and trace elements in the blood significantly improves the patient's condition and has a positive effect on the course of the disease.

With this complication, one should be especially careful about the introduction and duration of parenteral nutrition, since the soluble amino acids introduced at the same time can have a toxic effect on the liver.

Sclerosing cholangitis

One of the most formidable complications of NUC. Hereditary and immunological factors are of great importance in its development.

It is characterized by inflammatory fibrosis, strictures of the extrahepatic and intrahepatic bile ducts, and may be accompanied by pancreatitis. This pathology is more common in young men and is manifested by the following symptoms:

• skin itching;
• fever;
• pain in the right hypochondrium.

Stones in the gallbladder

Gallstone disease develops in ulcerative colitis, as a consequence of malabsorption of bile acids in the jejunum due to chronic diarrhea.

Urolithiasis disease

The severity of the disease is directly related to the extent of the lesion of the jejunum. With diarrhea, bile acids and calcium bind, and food oxalates remain in the intestinal lumen and are intensively absorbed with increased permeability of the intestinal mucosa.

Changes in the blood

As a rule, with ulcerative colitis, iron deficiency anemia, B₁₂-deficiency anemia, and autoimmune hemolytic anemia develop.

With NUC, the risk of developing phlebothrombosis increases. The reason for this is the high level of fibrinogen in the acute phase of the disease and the low concentration of antithrombin.

External factors that provoke this complication include hydration, bed rest, parenteral nutrition.

There may be hepatic vein thrombosis, pulmonary embolism, which can be the cause of death in inflammatory bowel diseases.

Rare extraintestinal complications in ulcerative colitis

In medical practice, relatively rare cases of diseases have been noted, the development of which is also directly related to ulcerative colitis:

• bronchopulmonary diseases (pulmonary fibrosis, bronchitis, bronchiectasis),
• heart disease (myocarditis, pericarditis, septic endocarditis).

With the development of these diseases and the ineffectiveness of their treatment, an examination of the gastrointestinal tract should be carried out, since if they are complications of its inflammation, then without complex therapy it is impossible to achieve a good result.

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Congenital aganglionosis of the colon. Constipation and even obstruction of the colon in newborns are found in many diseases. In most cases, they are caused by congenital diseases, cerebral hemorrhage, shock, sepsis, hypoxia. Meconium leaves a healthy child during the first day. Constipation for several days leads to repeated vomiting and bloating. If a digital examination of the rectum is accompanied by a passage of meconium, then it is considered very likely that constipation and functional intestinal obstruction are associated with colonic aganglionosis.
This disease was first described in the 17th century. In 1886, the Danish clinician Hirschprang demonstrated to the Berlin Pediatric Society the results of his observations of two boys who died at the age of 7 and 11 months and who from birth had a large belly and suffered from partial intestinal obstruction. He was the first to point out the connection of chronic constipation with dilatation of the large intestine and hypertrophy of its wall. It is now established that the disease described by Hirschprang is caused by congenital aganglionosis, which in mild cases is found only in the rectum, and in more severe cases extends to part or even the entire colon. Dilatation of the intestine is always accompanied by its general elongation and thickening of the wall; the intestine increased in all sizes was designated by the term "megacolon".

The severity of the clinical picture of Hirschsprung's disease depends on the length of the aganglionic segment of the colon. In mild cases of this disease, especially in breastfed infants, normal soft feces easily pass through a short aganglionic segment. In more severe cases, constipation appears, the severity of which depends on the length of the affected segment of the intestine and on the consistency of the fecal masses that come to it. In some cases, persistent constipation begins only in the second decade of life.

Initially, they are mistaken for simple constipation, since colonostasis can be overcome with enemas. Gradually, constipation becomes more and more persistent, and the patient develops the classic signs of the disease: a large belly, vomiting. When defecation occurs spontaneously, feces are released in the form of a thin cylinder and their volume is much less than normal.
Gradually, the large intestine, located proximal to the aganglionic segment, overflows with feces, expands and is palpated in the left iliac region in the form of a thick cylinder. An increase in her peristalsis can be easily detected by auscultation or even examination. The abdomen is noticeably stretched, its skin becomes thin and shiny. In more severe cases, bowel movements occur once every few days and usually only after an enema or after taking a laxative. Sometimes there is vomiting and partial intestinal obstruction, as a rule, emaciation and anemia are found.
Finger examination reveals normal anal sphincter tone. The rectal ampulla is empty or contains small, pea-sized lumps of feces. Colonoscopy reveals normal size and normal appearance of the distal colon mucosa. The colonoscope or rectoscope passes freely into the enlarged colon. The mucosa of this department is thickened, hyperemic, usually small superficial ulcers are often found on its surface. A barium enema reveals a normal diameter of the distal colon and a significantly enlarged proximal colon. In doubtful cases, a biopsy of the intestinal wall is performed. For Hirschsprung's disease, the absence of ganglion cells in the Auerbach plexus of the distal segment of the intestine is pathognomonic.

Prolonged stagnation of stool in the colon, located proximal to its aganglionic section, is complicated over time by the formation of coprolites. The pressure of the latter on the intestinal wall leads to the formation of ulcers. These ulcers are in most cases superficial, but occasionally they are complicated by bleeding or perforation of the intestine. One of the rare complications is enterocolitis - diarrhea with fever, vomiting and even more severe distension of the abdomen.
The diagnosis of Hirschsprung's disease can be assumed in every patient suffering from constipation since childhood. This assumption should be considered justified if, simultaneously with constipation, feces in the enlarged abdomen are palpated in the patient, and the rectum is free of feces. The final diagnosis is based on biopsy data.

Achalasia of the rectum. A sharp narrowing of the lumen of the distal segment of the rectum, as well as a sharp narrowing of the terminal esophagus, is commonly referred to as "achalasia". The clinical picture of this developmental anomaly is no different from the picture of colon aganglionosis. Carriers of this anomaly suffer from persistent constipation from infancy. The accumulation of a large amount of feces in front of the narrowed segment of the rectum leads to the expansion of its proximal sections.

Simultaneous pronounced expansion of the colon is accompanied by a pronounced increase in the abdomen. Prolonged stagnation of stool is often complicated by the formation of coprolites, which in turn can lead to the formation of stercoral ulcers and even perforation of the intestine and peritonitis. From time to time the disease is complicated by partial intestinal obstruction. A digital examination of the rectum reveals signs identical to those of colon aganglionosis.

The rectum sometimes turns out to be narrowed over only a distal 2-5 cm. In such cases, its narrowed section and transition zone are located in the small pelvis and cannot be detected by conventional X-ray examination. To diagnose this anomaly, the response of the internal sphincter to rectal distension or rectal sensitivity to acetylcholine and its analogues is more often examined.

The tone of the internal sphincter during stretching of the rectum in a healthy person decreases sharply, and in a patient with colon aganglionosis and rectal achalasia it increases. Parenteral injection of acetylcholine results in relaxation of the normally innervated colon. Injection of acetylcholine does not affect the height of intra-intestinal pressure in the segment of the intestine devoid of ganglion cells.

The wall of the narrowed section of the rectum in a patient with achalasia contains a normal number of ganglion cells, however, in functional terms, this section of the intestine is similar in everything to the intestine, devoid of ganglion cells. After the injection of acetylcholine, peristalsis and pressure in this area of ​​the intestine remain unchanged. The tone of the internal sphincter during stretching of the rectum in these patients increases. The clinical picture of colon aganglionosis and rectal achalasia are identical, they can be distinguished from each other only by biopsy data.

Nonspecific ulcerative colitis is a fairly rare disease in which there is inflammation and destruction of the tissues of the large intestine. In most patients with ulcerative colitis, the disease involves the rectum, just above the anus, and gradually spreads higher, involving the sigmoid colon and, in some cases, the entire large intestine.

Nonspecific ulcerative colitis usually develops in the form of alternating episodes of exacerbation and remission of the disease. Approximately 50% of patients, after the first exacerbation, the second happens within the next 2 years. In 40% of patients, exacerbations of the disease can occur and follow one after another. In 10% of patients, exacerbations occur extremely rarely.

Sleeping less than 6 hours or more than 9 hours may contribute to ulcerative colitis, published in the journal Clinical Gastroenterology and Hepatology. "Both insufficient sleep and excess sleep are associated with increased mortality."

The name of the disease is deciphered as follows:

• The term "non-specific" means that the disease occurs on its own, without any specific external cause.
• The term "ulcerative" refers to the condition of the intestine in this disease. During the period of exacerbation in patients with UC, the intestinal mucosa is covered with multiple bleeding ulcers.
• The term "colitis" means "inflammation of the large intestine".

Complications of nonspecific ulcerative colitis

The most common symptom of colitis flare-ups is bloody diarrhea. With the help of special medicines, the symptoms of exacerbations can be alleviated. These situations can be avoided by taking medications such as mesalazine every day. Rarely, surgery is needed to remove the colon.

Patients with colitis are at high risk of developing colon cancer. This risk can be reduced by taking mesalazine daily. However, patients with ulcerative colitis should be monitored regularly for precancerous lesions.

The appearance of colitis is possible at any age, but most often it is found in patients from 10 to 40 years old. In one out of seven cases, this disease occurs in older people 60 years and older. An interesting fact is that non-smokers are more prone to colitis than smokers. As you know, smoking causes significant damage to a healthy body, so it is not recommended to use it as a means to prevent colitis. Consider the most common complications of nonspecific ulcerative colitis .

Toxic dilatation of the colon

One of the most severe complications of NUC. Toxic dilatation occurs due to spasm of the underlying parts of the intestine, which leads to stagnation in the intestine and an increase in pressure, under the influence of which the intestine has no choice but to stretch.

Stretching is accompanied by disorders in the control of the muscular apparatus. The affected part of the intestine completely loses the ability to actively promote the food bolus and turns into an expanded immovable reservoir, in which feces accumulate more and more, decay and fermentation develop. Intestinal obstruction occurs, intoxication increases and in 30-40% of cases the death of the patient occurs.

Perforation and peritonitis

If the ulcer of the intestine is deep enough, then it is possible to perforate it, then the contents of the intestine enter the abdominal cavity. Normally, the abdominal cavity is sterile, so millions of bacteria from an infected intestine that have got there cause severe inflammation. In principle, the symptoms, course and prognosis of peritonitis in UC are no different from peritonitis with perforation of a gastric or duodenal ulcer, although the contents of the intestine are much richer in bacteria than the stomach.

With ulcerative colitis, bleeding from the formed ulcers always develops, sometimes quite plentiful up to 300 ml per day. Such bleeding for several days, and even against the background of dehydration, can lead to the development of shock and death of the patient. Given the already rather serious condition of patients, it is not always possible to clearly determine where the symptoms of dehydration are, and where the blood loss is. Pallor, weakness, low blood pressure and tachycardia should always be alarming, perhaps it is blood loss that lies under these symptoms.

Bowel stricture

A stricture is an adhesion formed between two ulcers as they heal. Strictures are most dangerous for the development of intestinal obstruction, which manifests itself in the form of a violation of the discharge of feces and gases, which causes the corresponding picture and is an acute surgical pathology. Sometimes strictures may not be critical and exist for years and only manifest themselves under certain conditions.

colon cancer

It is believed that ulcerative colitis is a precancerous condition and the development of a tumor is only a matter of time. The greatest risk is in patients who have had ulcerative colitis for more than 7-15 years. It is for this reason that such patients should undergo a diagnostic examination once a year.

Local and systemic complications in ulcerative colitis

In ulcerative colitis, a variety of complications are observed, which can be divided into local and systemic. Local complications include colon perforation, acute toxic dilatation of the colon, massive intestinal bleeding, colon cancer.

Acute toxic dilatation of the colon is one of the most dangerous complications of ulcerative colitis. It develops as a result of a severe ulcerative necrotic process and associated toxicosis. Toxic dilatation is characterized by the expansion of a segment or the entire affected intestine during a severe attack of ulcerative colitis. Patients with toxic dilatation of the colon in the initial stages require intensive conservative therapy. If it fails, surgery is performed.

Colon perforation is the most common cause of death in fulminant ulcerative colitis, especially in the development of acute toxic dilatation. Due to the extensive ulcerative-necrotic process, the wall of the colon becomes thinner, loses its barrier functions and becomes permeable to a variety of toxic products located in the intestinal lumen. In addition to stretching the intestinal wall, the bacterial flora, especially E. coli with pathogenic properties, plays a decisive role in the occurrence of perforation. In the chronic stage of the disease, this complication is rare and occurs mainly in the form of a pericolytic abscess. Treatment of perforation is only surgical.

Massive intestinal bleeding is relatively rare and, as a complication, is a less complex problem than acute toxic dilatation of the colon and perforation. In most patients with bleeding, adequate anti-inflammatory and hemostatic therapy avoids surgery. With ongoing massive intestinal bleeding in patients with ulcerative colitis, surgery is indicated.

The risk of developing colon cancer in ulcerative colitis increases dramatically with a disease duration of more than 10 years, if colitis began before the age of 18 years.

Sources: www.kolit.su, www.gastra.ru, proctolog.org, gastroscan.ru, www.sitemedical.ru, kronportal.ru

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Surgery to repair the rectum

The large intestine is the final section of the digestive tract, responsible for the absorption of liquid, glucose, electrolytes, vitamins and amino acids from processed food. Here, a fecal lump is formed from the digested mass and transported out through the rectum. The large intestine is a segment of the gastrointestinal tract that is most susceptible to numerous diseases: inflammation, tumor formation, and absorption of nutrients.

Diseases in the colon often mature unnoticed by a person. When the first symptoms appear, expressed in uncomfortable sensations in the abdomen, they are not particularly paid attention to, taking them for a common disorder:

• problems with stool (diarrhea, constipation, their alternation);
• flatulence, rumbling, a feeling of fullness in the abdomen, more often occurring in the evening;
• pain in the anus, on the sides of the abdomen, subsiding after defecation, gas release.

Over time, the signs of problems progress. Intestinal discomfort is accompanied by discharge from the anus of a mucous, purulent, bloody nature, there are sensations of constant pressure in the anus, unproductive urge to go to the toilet, "embarrassment" with involuntary discharge of gases and feces. As a rule, such phenomena are observed when the disease has already reached a mature stage.

A number of diseases cause poor absorption of nutrients in the large intestine, as a result of which the patient begins to lose weight, experience weakness, beriberi, and development and growth are disturbed in children. Diseases such as tumors are often discovered when a patient comes into surgery with an intestinal obstruction. Consider some diseases of the large intestine in more detail.

Ulcerative colitis: symptoms and treatment

With severe symptoms of inflammation, drugs are prescribed to destroy clostridia - Vancomycin or Metronidazole. In a severe course of the disease, the patient is hospitalized, since the most severe consequences are possible: toxic expansion of the intestine, peritonitis, heart attack, up to death. In any form of clostridial dysbacteriosis, it is forbidden to stop diarrhea with antidiarrheal drugs.

Neoplasms are the most dangerous diseases of the large intestine

Intestinal tumors – one of the most common neoplasms in the human body. occupies an "honorable" first place among oncological diseases. Malignant neoplasms with localization in the colon and rectum significantly predominate over benign tumors.

According to the statistics of intestinal oncology, people over 40 years of age are most susceptible, and the risks increase with age. The main factor that acts as a reason for the rapid spread of colon cancer is malnutrition. This is a diet poor in insoluble fiber and vitamins, consisting mainly of refined foods, containing a large amount of animal and trans fats, artificial additives.

Doctors also warn of an increased risk of those who have a hereditary predisposition to the growth of polyps, have a history of bowel cancer in the family, and are diagnosed with chronic inflammation of the mucous membrane, especially ulcerative colitis.

The insidiousness of polyps and tumors growing in the intestinal lumen is that they are practically asymptomatic for a long time. It is very difficult to suspect cancer in the early stages. As a rule, neoplasms are found by chance during endoscopic studies or x-rays. And if this did not happen, the patient begins to feel the signs of the disease when it has already gone far.

Common symptoms of a neoplasm in the colon are constipation, soreness, blood elements in the stool. The severity of the symptoms largely depends on the location of the cancer. In 75% of cases, the tumor grows in the left side of the colon, and in this case, complaints arise quickly and rapidly increase: excruciating "toilet" problems, pain attacks, indicating the development of intestinal obstruction. The location of the formation in the right half is 5 times less common, and it provides a long latent period of oncology. The patient begins to worry when, in addition to frequent diarrhea, he notices weakness, fever, and weight loss.

Since all intestinal problems are similar in their symptoms, a tumor process can never be ruled out. If there are complaints about the work of the intestines, it is better to consult a doctor and undergo an examination: donate feces for occult blood, do a colonoscopy or sigmoidoscopy, if there are polyps, check them for oncogenicity through a biopsy.

Treatment for bowel cancer is radical. The operation is combined with chemotherapy, radiation. With a favorable outcome, in order to avoid relapse, regular monitoring of the intestine for neoplasms of any nature and a lifelong healthy diet, physical activity, and the rejection of bad habits are mandatory.

This disease has several names: dyskinesia, mucous colitis, spastic bowel. is an intestinal disorder associated with impaired motility of the colon. This pathology may be due to concomitant diseases of the gastrointestinal tract, that is, to be secondary. Irritable bowel, caused directly by motor dysfunction, is an independent disease.

Various factors can influence the motor activity of the intestine:

• acute intestinal infection in history;
• lack of fiber in the diet;
• enzymatic deficiency, as a result - intolerance to certain foods;
• food allergy;
• dysbacteriosis;
• chronic colitis;
• transferred severe stress;
• general emotional instability, a tendency to psychosomatic states.

The mechanism of peristalsis failure in IBS is not fully understood, but it is well established that it is caused by impaired nervous regulation and hormonal production of the intestine itself.

Irritable bowel differs from other diseases in the vagueness of its symptoms. Discomfort in the abdomen is present almost constantly, however, it is not possible to unambiguously determine the localization of pain, their nature, and the alleged provoking factor. The patient's stomach hurts and growls, he is tormented by diarrhea, constipation, which replace each other, and all this regardless of changes in nutrition, that is, no diet helps in this case. IBS can cause discomfort in the back, joints, and radiate to the heart, despite the fact that no signs of pathology are found in these organs.

When diagnosing a spastic intestine, the doctor must first rule out oncology and other dangerous intestinal diseases. And only after a comprehensive examination of the gastrointestinal tract and the removal of suspicion of other diseases, the patient can receive a diagnosis of IBS. Often it is based on the subjective complaints of the patient and a thorough history taking, which allows you to establish the cause of this condition. This is very important, since effective treatment of IBS is impossible without determining the cause that provoked dyskinesia.

During treatment, emphasis should be placed on measures aimed at eliminating adverse factors: in case of psychosomatics - on sedative therapy, in case of allergies - on desensitization of the body, etc. The general principles for the treatment of irritable bowel are as follows:

Diverticula of the large intestine

A diverticulum is a stretching of the intestinal wall with the formation of a "pocket" protruding into the abdominal cavity. The main risk factors for this pathology are a weak tone of the intestinal walls. The favorite localization of diverticula is the sigmoid and descending sections of the large intestine.

Uncomplicated diverticula may not cause any discomfort to the patient, except for the usual constipation and heaviness in the abdomen. But against the background of dysbacteriosis and stagnation of the contents in the cavity of the diverticulum, inflammation can occur - diverticulitis.

Diverticulitis manifests itself acutely: abdominal pain, diarrhea with mucus and blood, high fever. With multiple diverticula and the inability to restore the tone of the intestinal wall, diverticulitis can become chronic. The diagnosis is established after endoscopic examination of the colon and x-ray.

Diverticulitis is treated with antibacterial drugs, and after the acute form is removed, beneficial microflora is introduced. Patients with uncomplicated diverticula are shown proper nutrition, which establishes normal bowel movement and prevents constipation.

If persistent multiple diverticula have formed, long-term therapy with sulfasalisin and enzymatic agents is recommended to prevent their inflammation. In the event of complications with signs of an "acute" abdomen, surgical intervention is performed.

Congenital and acquired anomalies in the structure of the colon

Anomalies in the structure of the large intestine include:

• dolichosigma - lengthening of the sigmoid colon;
• megacolon - hypertorophy of the colon along the entire length or in separate segments.

An elongated sigmoid colon may exist asymptomatically, but is more often manifested by chronic constipation and flatulence. Due to the large length of the intestine, the passage of feces is difficult, stagnation, accumulation of gases is formed. This condition can only be recognized on an x-ray showing a sigma anomaly.

Treatment of dolichosigma is to normalize the stool. A laxative diet, bran, laxatives are recommended. If these measures do not bring results, a prompt solution to the problem is possible. Surgical intervention is indicated if the lengthening of the intestine is significant, with the formation of an additional loop that prevents the normal evacuation of food masses.

Suspect megacolon allow persistent constipation, accompanied by severe pain and bloating. The chair may be absent for a long time - from 3 days to several weeks, since the feces linger in the dilated intestine and do not move further. Outwardly, megacolon can be manifested by an increase in the volume of the abdomen, stretching of the anterior abdominal wall, signs of fecal intoxication of the body, and bilious vomiting.

The cause of megacolon is congenital or acquired innervation of the large intestine due to embryonic disorders, toxic effects, injuries, tumors, and certain diseases. If a narrowed segment of the intestine occurs due to a mechanical obstacle or obstruction, an enlarged area is formed above it. In the innervated walls, muscle tissue is replaced by connective tissue, as a result of which peristalsis completely stops.

Most often, megacolon is located in the sigmoid area (megasigma). Expansion of the large intestine can be detected by x-ray. This diagnosis must be differentiated from true intestinal obstruction requiring immediate surgical intervention. - eliminated radically in childhood.

With a mild course of pathology, conservative treatment is carried out:

• high fiber diet;
• elimination of dysbacteriosis;
• intake of enzymes;
• mechanical and drug stimulation of motor skills;
• physiotherapy and therapeutic exercises.

Megacolon, complicated by poisoning of the body with fecal toxins, acute intestinal obstruction, fecal peritonitis, tumor and other dangerous conditions, requires excision of the affected part of the intestine.

Most diseases of the large intestine have a similar clinical picture, so a timely visit to a doctor greatly facilitates the diagnosis and avoids irreparable consequences for the life and health of the patient. Be sure to visit a specialist for the following complaints:

• the appearance of blood in the stool;
• abdominal pain that does not go away for more than 6 hours;
• prolonged absence of stool;
• frequent constipation or diarrhea.