Abstract
Introduction. Chronic constipation affects 14–16% of the developed countries population, thus remaining an important problem of modern coloproctology. To substantiate an objective treatment, it is elevant to look at not only clinical, laboratory, and instrumental data, but also at morphogenesis of structural colon changes at different stages of chronic constipation. Materials and methods. We studied postoperative material of 30 patients with drug-resistant chronic constipation at subcompensated (SC) and decompensated (DC) stages. The comparison group (CG) included 30 cases of colon resection for non-recurrent colorectal cancer. Morphometry of mucous membrane structural elements and neuromuscular and lymphoid apparatus was carried out. Results. Quantitative analysis of structural colon elements at SC stage indicates reversible atrophic changes and thickening of submucosal and muscular membranes, mainly due to edema and hypertrophy. Simultaneously, atrophic changes at DC stage are irreversible, with sclerotic, dystrophic, and atrophic changes being observed in submucosal and muscular membranes. As chronic constipation progresses, the number of nerve cells in the neuromuscular apparatus of the colon decreases significantly. Morphogenesis of lymphoid formations is limited to the development of a compensatory adaptive reaction as protective hyperplasia at SC stage, without simultaneous increase in the specific proportion of secondary lymphoid follicles. Although at DS stage, the average number and specific proportion of lymphoid formations in the mucosal and submucosal layers of the colon increase; the average area of lymphoid formations decreases markedly; and no secondary lymphoid follicles are observed. Conclusion. The established patterns of the colon wall morphogenesis in chronic constipation provide us objective causes to confirm the irreversible progression of pathological processes in all its functionally significant structures. This, based on the morphometric criteria obtained, serves as a recommendation for finding the most optimal treatment option for such patients. Keywords: chronic constipation, morphometry
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