SPECIFICS OF THE TREATMENT OF THE SURGICAL PATHOLOGIES, ACCOMPANYING WITH THE CHRONIC CONSTIPATION OF THE CHILDREN

R.SH. POLUKHOV

Azerbaijan Medical University, Baku, AZERBAIJAN

Introduction: since the chronic constipation of the children formed regarding with the several reasons, the determination of the factors, causing to the formation of the chronic constipation is the important matter for the selection of the proper treatment tactics.

Material and methods: 789 children, suffering from the chronic constipation passed the examination in the Clinic. During the examination it is determined that the reason of formation of the chronic constipation on 69 (8.65%) patients regarded with functional, 574 patients (71.92%) the development anomalies of the large intestine, 86 (10.78%) patients Hirsung`s disease and 69 (8.65%) anorectal anomalies.

Results: the patients with the functional constipation are sent to the pediatric clinics, the patients with Hirsung`s disease and anorectal anomalies passed the surgical treatment after the preparation. The conservative treatment is carried out on the patients with the development defects of the large intestine during 6-12 months. Conservative treatment of 466 (81.18%) patients was effective, the surgical treatment tactics was chosen on 108 (18,82%) patients, since the conservative treatment was not effective. Taking into consideration the degenerative alteration of the wall of the large intestine the volume of the resection is determined. Taking into consideration the volume of the resection, the formation variants of the collateral anastomosis was developed. On 91 (84.26%) patients the left-sided, on 7 (6.48%) transmesenterial, on 10 (9.26%) the right-sided descending was performed. All patients were discharged with the improvement after the operation.

Conclusion: the results show that it is reasonable to perform the left-sided descending of the large intestine up to the splenic curve on formation of the colorectal anastomosis (resection of the descending transversal colon and S-like intestine), transmesenterial descending on the resection of the transversal colon up to 3/1, the right-sided descending on the resection up to the elevating transversal colon or up to blind gut. Left-sided descending may be carried out instead of the transmesenterial descending if the vessel structure of the thick intestine is not corresponding.

DIAGNOSTICS AND TREATMENT OF THE DISTAL POLYPS OF LARGE INTESTINE IN CHILDREN

CH.B.GULIYEV, M.U. ISMAYILOV

Azerbaijan Medical University, Baku, AZERBAIJAN

Urgency of the problem. Polyps are considered to be benign masses of mucous tunic of intestine. In children, polyps occur in small and large intestine, mainly in rectum (90%). Intestinal polyps occur specially in children at the age of 3-8. Despite characteristic symptoms of rectal polyps, their diagnostics in most cases may create certain difficulties that may cause anemia in case of bleeding complications. Sometimes, children complain of pains. In case of inflammation of polyps tenesmus and frequent defecation are observed, that in most cased assessed as inflammation of large intestine or dysentery. Because of frequent occurrence of the disease, it shall be differentiated from other pathologies of rectum, which requires application of modern examination methods (rectoscopy, proctosigmoidoscopy, colonoscopy etc.). Exact diagnosis prevents long-term unnecessary conservative treatment. Apparently, diagnostics and treatment of distal polyps of large intestine remains an actual problem.

Materials and methods. Materials of the study are based on the treatment of 72 patients with the diagnosis of bleeding polyps of the rectum in the pediatric clinic of the Azerbaijan Medical University in 2000-2011. Of them 47 (65.3%) were boys, and 25 (34.7%) were girls. The smalles of the patients were at the age of 3, and the oldest at the age of 11. Anamnestic data is of great significance in the setting of the diagnosis of rectal polyp. All the patients passed general clinical examination, and after cleansing enema they passed rectal palpation. In 58 of 72 patients it was detected that polyp is located at the distance of 6-8 cm from the anus and on the rear wall of the rectum. In other 14 patients, localization of the polyp was possible only with the application of colonoscopy. During the examination, in 4 patients the polyp was located in the intraperitoneal part of the rectum, and in 10 patients in the sigmoid. Planned surgical intervention was carried out in 19 patients (bleeding of a polyp after tearing off the pedicle in 11, suffocation and necrosis of a polyp in 8 cases) that entered our clinic with distal polyps of the large intestine after urgent and in other 53 patients after complete clinical and instrumental examination. As a rule, polyps located in the rectum were removed from the anus. Polyps located in the sigmoid in 6 patients were removed endoscopically, and in 4 children by means of laparotomy, colonotomy because of wide pedicle and ulceration. Complications occurred in none of the patients.

Date: 2014-12-28; view: 916