MELENA (melaena; Greek melas, melanos black; synonym: tar-like chair, apoplexia intestinalis) — black kcal; pathognomonic symptom of esophageal, gastric and intestinal bleeding. A wedge, manifestations Are in direct dependence on amount of the streamed blood and time of its stay in went. - kish. path. Characteristic black color of excrements is explained by presence at the them of ferrous sulfide, a methemoglobin and hematin formed in intestines of hemoglobin of the streamed blood under the influence of intestinal enzymes and microbic flora.
Most often M. is observed after profuse bleedings from varicose veins of a gullet, from stomach ulcers or a duodenum, and also at Osler's syndromes — Randyu — Weber and Mallori — Weiss. This symptom arises also after the bleedings in a gleam of a digestive tract caused by erosive gastritis and a duodenitis, a diverticulitis, ulcerated tumors and polyps of a gullet, stomach and various departments of intestines, nek-ry general diseases of blood (Verlgof's disease, hemolitic jaundice, leukoses), vascular diseases (a capillary toxicosis, aneurisms, atherosclerotic defeat of vessels). The m can arise also at hernias of an esophageal opening of a diaphragm, invagination of intestines, cankers of a stomach and intestines of the syphilitic and tubercular nature, ulcer and inflammatory damages of a large intestine (nonspecific ulcer colitis, a disease Krone, dysentery, a typhoid, etc.).
Data of the anamnesis and objective research, and also rentgenol, researches of a gullet, a stomach and intestines are important for identification of a bleeding point. From the middle of the 60th of 20 century the crucial role in diagnosis of the reason for M. began to belong to endoscopic methods of a research (see. Gastroscopy , Duodenoskopiya , Intestinoskopiya , Kolonoskopiya , Rektoromanoskopiya ). By means of modern fibrogastroduodenoskop and fibrokolonoskop it is possible to examine almost all departments went. - kish. a path, including proximal and distal departments of a small bowel that allows to localize precisely at most of patients a source of M.
Profuse bleedings went to a gleam. - kish. a path, as a rule, are followed by diarrhea with allocation of the plentiful liquid fetid excrements having a characteristic varnish reflection and by outward reminding tar. At less plentiful bleedings the allocated excrements have black or dark cherry color and can be even issued. At patients with a melena the picture of posthemorrhagic anemia can develop, the azotemia of an extrarenal origin and fervescence due to the strengthened absorption of blood proteins from intestines quite often comes to light.
At differential diagnosis it is necessary to remember a possibility of emergence of black coloring of excrements after intake of iron preparations, bismuth and Carbolenum, and also after consumption of bilberry, currant, beet and nek-ry other products. With doubtful cases clarification of true character of M. is helped by a chemical research a calla (see. the Benzidine test ).
All patients, at to-rykh M. comes to light, are subject to the emergency hospitalization in surgical department. Lech. tactics is defined by M.'s reason and character went. - kish. bleedings (see. Gastrointestinal bleeding ).
The melena at children
the Melena at children can be caused by the same reasons, as at adults. The hemorrhagic disease of newborns is M.'s reason of newborns (melaena neonatorum), at a cut there is diapedetic bleeding from capillaries of a mucous membrane of a stomach and intestines to a gleam went. - kish. path. The m of newborns meets, as a rule, on 1 week of life, a thicket during the winter or spring period. Color the calla at M. of newborns usually has a crimson shade owing to mixing of the changed and not changed blood from various departments of intestines. Weight of a condition of the child depends on degree of blood loss. The m of newborns needs to be differentiated with a syndrome of the swallowed blood when dark the kcal at the child is a consequence of hit in went. - kish. a path of maternal blood from nipple cracks during the feeding, and also at bleedings from a mucous membrane of a mouth or a nasopharynx of the child. Differential diagnosis is helped by survey of mammary glands of mother, a nasopharynx of the child, and also a lab. researches (Apt's test — Downer).
The m of newborns demands urgent to lay down. the actions consisting in completion of blood loss by transfusion of svezhezagotovlenny blood and purpose of haemo static drugs.
Bibliography: Bratus V. D. Acute gastric bleedings, Kiev, 1972; Doletsky S. Ya., Gavryushov V. V. and Akopyan V. G. Surgery of newborns, page 80, M., 1976; To e r-p e of l-F ronius E. Pediatriya, the lane with Wenger., Budapest, 1977; The Guide to an urgent surgery of abdominal organs, under the editorship of V. S. Savelyev, page 402, M., 1976; V. I. Pods, etc. Gastrointestinal bleedings and fibro - endoscopy, M., 1977, bibliogr.; D about Ь-n i S. Surgery of the intestines, Budapest, 1976.
V. V. Sergevnin; S. M. Krivorak (ped.).