CONSERVATIVE TREATMENT OF CHRONIC COLOSTASIS IN CHILDREN WITH DOLICHOSIGMA

Abstract

Relevance. The normal frequency of defecation in childhood varies from 2–3 times a day to 3 times a week. However, in most cases of chronic colostasis in children with dolichosigma, it manifests as a systematic decrease in bowel movements and incomplete intestinal emptying over a long period, leading to stool compaction, expansion of the additional sigmoid colon loop, decreased receptor sensitivity, which ultimately causes progression of colostasis, disruption of the colonic biocenosis, and increased clinical symptoms.

Objective. To improve the outcomes of conservative treatment of chronic colostasis in children with dolichosigma.

Materials and Methods. From 2015 to 2025, 174 patients with chronic colostasis were hospitalized at the TSMU clinic, of whom 80 (45.9%) were diagnosed with dolichosigma (elongated sigmoid colon due to additional loops freely moving in the abdominal cavity). Among all examined patients, the compensated stage was detected in 53 cases (66.2%), the subcompensated stage in 21 cases (26.3%), and the decompensated stage, which is a severe clinical form of dolichosigma, in 6 cases (7.5%).

Results. Conservative therapy consisted of several stages and included: dietary regulation with prescription of a laxative diet; age-appropriate medications stimulating intestinal peristalsis, Forlax 4 g (polyethylene glycol), B-group vitamin complex, laxatives and antispasmodics; lyophilized probiotic complex “Bifolak®-Active” (containing more than 1 trillion beneficial bacteria per sachet/capsule); as well as daily cleansing enemas to develop the defecation reflex. Good and satisfactory results were observed in patients with compensated and subcompensated stages, including normalization of intestinal biocenosis, regular spontaneous bowel movements, and absence of anxiety and abdominal distension. Outcomes depended on early diagnosis and timely conservative therapy. In 5 of 6 patients with decompensated stage, conservative therapy was ineffective and surgical treatment (sigmoid colon resection) was required due to persistent constipation, non-reducible loops, and prolonged colostasis with fecal intoxication.

Conclusion. Comprehensive conservative therapy with Forlax and probiotics in children with dolichosigma is the most effective treatment approach, enabling regular spontaneous bowel movements, relief of abdominal pain, normalization of intestinal biocenosis, and improved quality of life. Surgical intervention is rarely required and indicated only in cases of ineffective conservative therapy, persistent chronic constipation with fecal stones, and severe cases leading to intestinal obstruction.