Pediatric constipation conditions and their associated diseases

  Constipation is a common disease that occurs to varying degrees at different times throughout life in both adults and children, and according to statistics constipation accounts for 2-10% in adults and about 5% in children. First of all, the time for food to pass through the digestive tract is related to age. After eating, the small intestine will have a mobile motor complex wave, pushing the food towards the end of the ileum at about 5cm per hour, and then the small intestine contents will enter the colon after passing through the cecum, and the colon will push the intestine contents to the distal end mainly through group movement, and the residue will enter the rectal jug abdomen and stimulate the local sensory nerve reflexes, thus causing the desire to defecate. This regular bowel movement can reduce the stagnation of intestinal tube and bacterial overgrowth on the one hand, and reduce the burden of intestinal tube and excessive absorption of toxins on the other hand.  There are several clinical possibilities for constipation, including functional, organic, pharmacological, etc.  (1) Organic lesions of the intestinal canal, such as tumors, inflammation, developmental malformations, and even foreign body or parasitic injuries.  (2) Recto-anal lesions: anal stenosis, anal fissure, anal fistula, endorectal prolapse, hemorrhoids, anterior rectal bulge, puborectal hypertrophy, pelvic floor disease, etc.  (3) Endocrine and metabolic diseases: hypothyroidism, parathyroid disease, diabetes mellitus, abnormal amino acid metabolism, etc.  (4) Neurological disorders: central brain diseases, spinal cord injury, peripheral neuropathy, etc. Other aspects, etc.  For newborns and children with constipation mainly pay attention to the following two kinds of intestinal organic lesions: i. It is congenital megacolon: its main feature is that more than 90% of the fetal stool is not passed or delayed after birth, and the persistent constipation is aggravated, the abdominal distension is obvious, and the intestinal pattern and peristaltic waves are visible. Stenosis and dilated segments are seen on barium enema, and barium residue is seen on 24-hour recheck plain film. There was no internal sphincter relaxation reflex on rectal manometry, and the rectal mucosal histochemistry was positive for AchE +~+++, and no ganglion cells were present in the pathologically stenosed segment.  Second, is the giant colon homozygous disease (or some called class edge disease) constipation symptoms can appear later, most in a few months or half a year later, abdominal distension does not appear, constipation gradually aggravated, sometimes there is a short-term remission period, barium enema stenosis segment low or inconspicuous, dilated segment length varies, manometry can appear atypical relaxation reflex, histochemical examination according to the depth of sampling performance (+ ~ -) pathological examination can have ganglion cells, however, the number and quality of its cells However, the number and quality of the cells are abnormal. The features are (1) large plexus and ganglion cells (more than 7 cells per ganglion) (2) elevated acetylcholinesterase activity (3) abnormal isolated ganglion cells (4) incomplete or undeveloped sympathetic nerves in the intermuscular plexus of type A.  With regard to treatment, Scharle believes that 90% of cases are curable after surgery following early detection and diagnosis. Among others, it is also believed that most ultrashort segmental types and some homologous diseases can be treated conservatively for 6 months. Surgery is generally considered to be a radical procedure that requires removal of the entire diseased intestinal canal, otherwise it is prone to recurrence. Some foreign scholars have reported that most of the recurrences are homologous, and the common type of megacolon has a better cure.