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.

SIGNIFICANCE OF ANTIOXIDANT THERAPY ON HIRSHPRUNG`S DISEASE OF CHILDREN

CH.B. GULIYEV, R.SH. POLUKHOV, V.A. MAHAMMADOV

Azerbaijan Medical University, Baku, AZERBAIJAN

Hirshprung`s disease, being the severe development defect of the distal part of the large intestine, however, the improvement of the treatment methods, still, the non-satisfactory results are stated on postoperation period. The reason on arising of these results is the regulation of the pathological alterations, arisen in the children’s organism. Taking into consideration the above stated, the analysis of 54 children, admitted to the Clinic with the diagnosis of Hirshprung`s disease is carried out at the Department of children’s surgery. Beside the general examination, the determination of glutation (GSH) catalasis (CAT), restored from antioxidant defense system and malon dialdehyds (MDA), dien conugates (DC) of the peroxidation products of the lipids of the patient’s blood. During the initial examination, the acute increasing of MDA of malon dialdehyd, DC of peroxidation products of the lipids and contrary the reduction of CAT concentration, GSH by antioxidant defense system are stated on the patients. Generally, the relation between clinical course of the disease, term of the continuation of the disease, clinical phase of the disease on peroxidation process of the lipids are determined on Hirshprung`s disease. So, that the peroxidation products of the lipids acutely increased on sub-decompensation phases of the disease, on the diseases, which’s clinical type continues on acute bowel obstruction of the children, included to the adult’s group and whose period of the disease last for long time, contrarily the high suppression of the indices of antioxidant defense system is stated. Taking into consideration the above stated, antioxidant therapy is applied on 18 patients, survived surgical intervention during prior operation period. Medicines with the composition of glutution (Ridutox) and coensime compositum are used as the antioxidant. After prior operation preparation the evaluation of the indices of antioxidant defense system and peroxidation process of lipids are carried out. MDA reduced to 51.2%, DC-22.9%, contrarily GSH reached to norm 49.3%, CAT to 30.1%. Taking into consideration the big-scale and traumatic character of the operation on Hirshprung`s disease, intensity of the peroxidation process of the lipids the antioxidant therapy on postoperation period is continued. On analyzing of the postoperation period the moderate and normal condition on the patients, passed antioxidant therapy is stated.

Thus, the application of the antioxidant therapy on Hirshprung`s disease caused to the flow of the postoperation period without complication through reduction of the toxic products of the lipid peroxidation.

THE APPLICATION OF ANTERIOR OVERLAPPING SPHINCTER LEVATOROPLASTY IN FAECAL INCONTINENCE DUE TO OBSTETRIC TRAUMA

M.H. HASANOVA

Republican Clinical Hospital named after acad. Mir-Qasimov, Baku, AZERBAIJAN

The surgical treatment of faecal incontinence is not only a medical but also a social problem that remains in the agenda of world proctologists. Such patients suffering from faecal incontinence prefer to isolate themselves from the community and face a variety of psychological problems soon. The majority of authors link faecal incontinence causes to obstetric trauma. Unfortunately even sphincter levatoroplasty cannot fully restore the functions of anal sphincter.

The aims of the study: we aim to reveal the effectiveness of anterior overlapping sphincter levatoroplasty in faecal incontinence caused by obstetric trauma. We had 90 patients with faecal incontinence due obstetric trauma. We visually revealed defects in sphincter anterior semi-ring and perineum and various degree of scarry changes accompanied with pus-necrotic process. Digital rectal investigation revealed total loss of anal sphincter tonus. The degree of anal sphincter insufficiency and muscle defect were identified with anorectal manometry, sphincterometry and ultrasound. The results of the study showed total loss of tonus of anal sphincter in all patients in anterior-posterior direction and considerable reduction in lateral directions. The defect of the sphincter margins of 16 patients was in ¼ of sphincter anterior semi-ring and in 74 patients was much wider. After the appropriate preoperative measures patients underwent anterior sphincter levatoroplasty. In 74 patients we performed typical levatoroplasty after mobilization of sphincter and end-to-end suture. The remaining 16 patients with much lesser defect underwent overlapping sphincter suture. The results of surgery were assessed according to clinical and instrumental investigations data. We found that overlapping sphincter levatoroplasty restored the normal function of anal sphincter. The results of anorectal manometry and sphincterometry were normal.

Date: 2014-12-28; view: 937