MODERN APPROACHES TO THE DIAGNOSIS AND TREATMENT OF CHRONIC CONSTIPATION ASSOCIATED WITH DOLICHOSIGMA IN CHILDREN

Abstract

Background. Chronic constipation in children remains one of the most common problems in pediatric gastroenterology and pediatric surgery, accounting for up to 25–30% of visits to specialized healthcare providers. Dolichosigma is one of the leading anatomical and functional causes of chronic constipation in childhood and is often accompanied by progressive disorders of colonic motor-evacuatory function, fecal impaction, and a decreased quality of life. In this context, the evaluation of modern conservative treatment methods, particularly osmotic laxatives based on polyethylene glycol, as well as the development of clear criteria for patient selection for surgical intervention, is of considerable clinical relevance.

Aim. To assess the clinical and diagnostic value of modern examination methods and the effectiveness of conservative therapy for chronic constipation associated with dolichosigma in children, with justification of strict indications for surgical treatment.

Materials and Methods. A prospective clinical observational study was conducted involving 86 children aged 3 to 15 years with chronic constipation associated with dolichosigma. The diagnosis was confirmed based on clinical findings and instrumental investigations, including abdominal ultrasonography and irrigography, which allowed assessment of the length, shape, and functional state of the sigmoid colon. The severity of constipation was evaluated according to defecation frequency, stool characteristics, intensity of abdominal pain, presence of fecal impaction, and signs of endogenous intoxication. Conservative treatment was the first-line approach and included non-pharmacological measures (dietary modification, optimization of fluid intake, and formation of a regular defecation reflex) as well as pharmacological therapy with an osmotic laxative—polyethylene glycol (PEG)—administered in age- and clinically appropriate doses. Treatment efficacy was assessed after 1, 3, and 6 months. Surgical intervention was considered only in cases of insufficient clinical response to prolonged comprehensive conservative therapy.

Results. Sustained clinical remission was achieved in 72 patients (83.7%) receiving conservative therapy with polyethylene glycol, manifested by normalization of stool frequency and consistency, reduction of abdominal pain, and resolution of symptoms of fecal intoxication. PEG demonstrated a high safety profile, good tolerability, and absence of dependence or electrolyte disturbances during long-term use. Conservative treatment was ineffective in 14 children (16.3%). This group showed signs of decompensated colonic motor-evacuatory dysfunction, recurrent fecal impaction, and significant deterioration in quality of life, which constituted indications for surgical treatment. Following surgical intervention, all operated patients demonstrated marked clinical improvement.

Conclusion. Modern management of children with chronic constipation associated with dolichosigma should be based on a stepwise and predominantly conservative approach. The use of polyethylene glycol is a pathogenetically justified, effective, and safe therapeutic option that allows clinical improvement in the majority of patients and significantly reduces the need for surgical intervention. Surgical treatment should be reserved for strictly defined indications, including failure of prolonged adequate conservative therapy and the development of complicated forms of the disease.