Congenital dilatation of the colon and constipation: What you need to know

The article is professionally consulted by Master, Doctor Duong Xuan Loc - Gastroenterologist - General Surgery Department - Vinmec Danang International General Hospital.

Hirschsprung's disease (HERSH-sproong) affects the large intestine (colon) making it difficult for the patient to empty the intestines, that is, stools are difficult to pass out due to lack of peristalsis. chronic constipation. Congenital dilatation is a congenital condition that begins at birth, although in milder cases symptoms may appear months or years later. Hirschsprung's disease can cause constipation, diarrhea, and vomiting. It sometimes leads to serious colon complications such as serious intestinal infections (enteritis) and toxic megacolon, which can be life-threatening. The cause of the disease is not really clear. The disease may be related to genetic mutations. Or some authors think that the cause is because the intestine lacks nerve cells in the lower part of the colon. It is caused by a birth defect. Normally, the large intestine moves digested matter through the intestines by a series of contractions called peristalsis.

This is controlled by nerves between layers of muscle tissue in the intestines. Children with Hirschsprung's disease are missing these nerves along part of the length of the colon. This prevents the colon from relaxing, which can cause a blockage of digestive material and make it difficult to pass. Nerves in the colon control muscle contractions that move food through the intestines. Without contractions, the stool remains in the large intestine.
Most children who are treated with surgery have good results. Most children can be completely cured and have no long-term complications. Some children may continue to have symptoms, including constipation and problems with bowel control.

Usually signs and symptoms appear soon after birth, but sometimes they are not apparent until later in life.
2.1 Symptoms in infants Symptoms of the disease can vary depending on the severity of the illness. Symptoms include:
If a child is very ill, they will usually have symptoms within the first few days of life. The most obvious sign is that an infant does not have a bowel movement within 48 hours of birth. This sign is valuable in diagnosis Other signs and symptoms in infants may include: Abdominal swelling, bloating, or gas The child has diarrhea Vomiting, which includes vomiting a green or brown substance Constipation can make babies fussy

2.2. Symptoms in older children Less severe cases may not be discovered until a child is a little older, or sometimes even later. Symptoms in these cases are usually milder but can be long-lasting (or chronic). Includes:
Children with difficulty in gaining weight, slow in physical development due to reduced absorption Vomiting or passing stools Swollen abdomen Chronic constipation Fatigue

Have a sibling with Hirschsprung disease. Hirschsprung disease can be inherited. If you have a conditional child, future biological children may be at risk. Is male. Hirschsprung disease is more common in men. There are other inheritance conditions. Hirschsprung disease is associated with a number of genetic diseases, such as Down syndrome, and other birth defects, such as congenital heart disease.

Diagnosis is based on clinical symptoms or hospitalization for intestinal obstruction. Then some laboratory indications will be given to help with the diagnosis:
Abdominal X-ray with contrast dye. Barium or other contrast dye is placed into the intestine through a special tube inserted into the rectum. The barium fills and coats the intestinal lining, creating a clear silhouette of the colon and rectum. An X-ray will usually show a clear contrast between the narrow part of the bowel that has no nerves and the normal but often swollen part of the bowel behind it. In some cases, the entire colon is dilated. Measure control of the muscles around the rectum (anal manometry). An anthropometric test is usually performed on older children and adults. The doctor inflates a balloon inside the rectum. The surrounding muscles should relax as a result. If not, Hirschsprung disease may be the cause. Remove a sample of colon tissue for testing (biopsy). This is the surest way to identify Hirschsprung's disease. A biopsy sample can be collected with an aspiration device, then examined under a microscope to determine if a neuron is missing.

Surgery is believed to be the most effective treatment for Hirschsprung's disease. The most common surgery to correct Hirschsprung's disease involves removing the part of the colon that has no nerves and reattaching the remainder to the rectum.
Usually this can be done in one step through minimally invasive surgery (laparoscopic) right after the condition is diagnosed. In case of total dilatation, it is necessary to perform a total colectomy to bring the ileum out and then anastomosis in the posterior phase.

If your child is constipated after surgery for congenital dilated colon, lifestyle changes should be made to minimize constipation. Measures include:
Diet with foods rich in fiber . Offer whole grains, fruits and vegetables and limit white bread and other low-fiber foods to help prevent constipation. Should drink more water. If part or all of your child's large intestine is removed, your child may have trouble absorbing enough water. Drinking more water can help keep your child hydrated, which can help relieve constipation. Encouraging daily physical activity helps promote bowel movements. Laxatives as directed by your doctor. If your child is unresponsive to or cannot tolerate increased fiber, water, or physical activity, certain laxatives -- medications to encourage bowel movements -- may help relieve constipation. . Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with a team of doctors, modern equipment and technology, but also stands out for its examination, consultation and treatment services. comprehensive, professional disease; civilized, polite, safe and sterile medical examination and treatment space.