SPLANCHNOPTOSIA (splanchnoptosis; Greek splanchna of an interior + - ptosis falling; synonym: visceroptosis, shift of internals, vesceral ptosis, enteroptosia, Glenar's disease) — shift of internals from top to bottom in comparison with their normal situation. Distinguish the secondary shift of body (possible in any direction) caused volume patol from S. processes, scarring, interposition of bodies, etc.
In 1761 J. Morganyi wrote about various deviations in an arrangement of internals, and in the 90th 19 century Glenar (S. M. of F. Glenard) the first described clinic of a vesceral ptosis, having called it an enteroptosia and a splanchnoptosia.
In an etiology and S.'s pathogeny can play a role of anomaly of development of bodies, weakening of fabrics (sheaves, mesenteries) attaching bodies to a back abdominal wall, decrease in a condition of a diaphragm, narrowing of the bottom of a thorax, falling of a tone of belly muscles, bystry and sharp reduction of amount of fatty tissue in an abdominal cavity and retroperitoneal cellulose, reduction of a lumbar lordosis, to-rye are quite often caused by hereditary and constitutional features of an organism. Distinguish constitutional and acquired by Page.
Constitutional S. is characteristic of people of asthenic constitutions (see), at to-rykh a thicket weak muscles, insufficiency of the general tone, the lowered fatness, nek-paradise inferiority of elastic elements are noted. The stomach at the same time takes the characteristic form — a so-called pendulous belly of maidens (fig. 1). Constitutional S. is more often observed at women and tall men.
The acquired S. is noted at very corpulent persons after sharp weight loss, especially in the presence they have emphysemas of lungs; at patients with it is long the existing ascites after evacuation of ascitic liquid; at patients is after removal of big tumors, cysts of an abdominal cavity, etc. Special value has the acquired S. developing in connection with weakening of muscles of a prelum abdominale after repeated pregnancies and a sort ov what is promoted weak preparation of muscles of a stomach during pregnancy (especially its last months) and their insufficient strengthening after the delivery, and also hard physical activity before the normal muscle tone is recovered. At the acquired S. the stomach also takes a peculiar form (fig. 2).
Wedge, manifestations at poorly expressed S. are absent more often. Sometimes there are uncertain abdominal pains, to-rye pass in a prone position, at pulling up of a stomach up hands or carrying a bandage. In the presence of the anatomic changes connected with the shift of this or that body there are symptoms of disturbance of functions of this body, napr, a stomach (see. Ventroptosis ).
Tendency to locks, the disiyeptichesky phenomena are characteristic of omission of departments of a large intestine — a coloptosia. At development of a coloenteritis locks alternate from ponosa. Omission of a caecum quite often is followed by its excessive mobility (caecum mobile). In these cases of patients disturb constant abdominal distention (see. Meteorism ), the dull aches in the right ileal area sometimes reminding an attack of an acute appendicitis, the phenomenon of the alternating intestinal impassability (see Impassability of intestines) up to torsion of a mobile caecum. Considerably omission of longer cross colon, edge meets more often besides has a long mesentery and is fixed in right (hepatic) and is especially strong in left (splenic) bends. At omission of a cross colon it gets the U-shaped form promoting stagnation of intestinal contents. During the progressing of process there is an expansion and lengthening of a gut causing the alternating intestinal impassability up to the full impassability at the level of the left (splenic) bend caused by the kink or torsion in this place of excessively long cross colon (Payr's syndrome). Omission of a sigmoid gut meets at its inborn lengthening and in the presence of a wide mesentery. In a gut there is a delay of dense fecal masses, locks with the expressed meteorism are noted. The configuration of a stomach at the same time changes. In a mucous membrane of a gut inflammatory process develops (see. Sigmoiditis ), ponosa with slime and blood periodically appear. The extended and lowered sigmoid gut partially is overwound by times, causing the phenomena of partial obstruction of intestines; quite often there is full (on 360 °) torsion of a sigmoid gut.
The hepatoptosis (hepatoptosis) meets rather seldom and the hl is observed. obrazokhm at women at the general S. Chashche takes place the isolated omission of the left share, is more rare than the right share, omission of all liver is even more rare. The displaced liver or its shares are deformed and gain considerable mobility. The small hepatoptosis is practically not shown. At more considerable hepatoptosis there is a feeling of weight, pain in right hypochondrium, sometimes irradiating in a shoulder, a shovel, a backbone, to-rye decrease or pass during the carrying a bandage. The considerable hepatoptosis is shown by disturbance of portal blood circulation and free intake of bile in intestines.
At a spleniptosis (splenoptosia) it quickly enough increases in volume due to disturbance of outflow of blood. There are dull aches in left hypochondrium, to-rye decrease in horizontal position of the patient.
Diagnosis and differential diagnosis Pages put on the basis of characteristic data of clinical and radiological researches. Diagnosis is helped, in particular, by diagnostic reception of Glenar: the doctor, standing behind from the patient, both hands placed over his pubis otdavlivat a stomach up; the termination of the abdominal pains which were before speaks about possible existence of Page.
S.'s radiodiagnosis is directed to establishment of level of an arrangement of abdominal organs or retroperitoneal space. Researches are conducted in horizontal and vertical provisions of the patient as under natural conditions, and at artificial contrasting went. - kish. path, liver or kidneys. If necessary in addition enter gas into an abdominal cavity (see. Pneumoperitoneum ) or retroperitoneal space (see. Pneumoretroperitoneum ).
At a gastroptosis (ventroptosis) find its very low situation, oversizes, the lowered tone, the weakened peristaltics and usually slowed down evacuation. Big curvature of a stomach is located 7 — 8 cm below than an ileal crest, reaching sometimes an entrance to a small pelvis. The gas bubble is extended, the gatekeeper and a bulb (an ampoule, T.) a duodenum are located vertically, the passage of barium is slowed down. Expressiveness of these disturbances depends on degree of a ventroptosis. The gastroptosis established radiological can be isolated or combined with omission of the gatekeeper and a duodenum (a ventroptosis with piloroduodenoptozy); the last is followed considerably by smaller disturbances motor evakuatornoy functions of a stomach. In case of the fixed ventroptosis, at Krom the stomach is spliced with the bottom of an abdominal wall, there is no smeshchayemost and deformation of walls of a stomach is found that can be revealed in lateroposition of the patient on the right side (see. Polyposition research ).
The low position of a stomach which is not followed a wedge, manifestations (as it quite often happens at astenik), usually consider as option of an anatomic structure. At a ventroptosis usually find omission and other bodies — a liver, kidneys, a spleen, intestines. The ventroptosis is differentiated with the atony of a stomach and its changes arising at a scleroderma, cicatricial and commissural process after vagisection, etc.
At omission of a large intestine the low provision of hepatic and splenic its bends, and also blind and cross colonic guts is defined. At the same time excessively mobile caecum can be in a small basin where also the cross colon (fig. 3) having an appearance of a garland quite often sags. The relief of a mucous membrane remains normal. The Smeshchayemost of a gut in the absence of commissures is not broken. In the lowered and extended gut additional loops, excesses, increase or decrease in a tone, delay of a passage of contents can be observed. The delay of contrast contents can reach 96 hours and more. Omission of departments of intestines needs to be differentiated with their secondary shift caused by volume or cicatricial and commissural process in an abdominal cavity or retroperitoneal space.
Omission of kidneys (nephroptosis) is usually established already at a survey X-ray analysis (tomography) of retroperitoneal space. Character of a nephroptosis and a condition of kidneys are specified by means of a contrast research of pyelocaliceal system and ureters (secretory or retrograde urography). On a wedge, to indications make a research of vessels of kidneys (fig. 4), a radio isotope research (see) or a computer tomography (see the Nephroptosis). The nephroptosis is differentiated with an inborn allotopia of a kidney, for a cut the low arrangement of a kidney and the short ureter deprived of the bends inherent to a nephroptosis are characteristic. At a computer tomography the considerable reduction of a perinephric fatty tissue promoting a nephroptosis is quite often noted (see. Tomography computer ).
The hepatoptosis is usually combined with omission of a gall bladder and a hepatic bend of a large intestine. Therefore it is diagnosed at a research in vertical position of the patient on the image of the bottom first line of a liver, and also gall bladder and large intestine at their contrast research. The hepatoptosis is differentiated with the true increase in a liver and its secondary infraplacement caused by interposition of a large intestine between a diaphragm and a liver or volume patol. processes in the right upper quadrant of a stomach. If necessary resort to a radio isotope research of a liver, its research in the conditions of a pneumoperitoneum or to a computer tomography.
Treatment The page is generally conservative. Dietary food, fortifying actions, hydroprocedures are shown to the exhausted patients. Dispeptic and motor disturbances from outside went. - kish. a path, neurogenic and other frustration demand special treatment depending on the nature of disturbances. The condition of the patient sometimes improves during the use of individual belly bandage (see), holding a pendulous belly.
A specific place in S.'s treatment is held by LFK. Regular trainings by physiotherapy exercises (see) make fortifying impact, promote increase in a tone of muscular system, especially muscles of a prelum abdominale and pelvic bottom, tone up a nervous system, stimulate motor function of a stomach. At S. apply remedial gymnastics (see), morning hygienic exercises (see. Charging ), unfatiguing pedestrian or ski walks, swimming, etc.
Occupations begin with the initial position of the patient lying on spin on a couch with the lifted foot end or enclosed under a basin by a pillow, the curtailed blanket. Use also a ventral decubitus, on one side, being kneeling. On the initial position standing pass after noticeable strengthening of muscles of a stomach and a pelvic bottom that is reached by exercises in the form of turns, assignments, reductions and rotations of a hip, retraction of an anus, walking with a muscle tension, etc. These exercises alternate with fortifying and respiratory. At the same time it is very useful to use the diaphragmal respiration accompanied with retraction of a stomach on an exhalation. The movements carry out at slow and average speed with a big amplitude and pauses for rest.
In the first two weeks give one classes a day, repeating each exercise of 3 — 5 times. Approximately in month of exercise and self-massage of a stomach do in the morning and after work (till a dinner or 2 hours later after it), number of repetitions of each exercise gradually increase to 10 — 15, avoiding at the same time exhaustion of the patient.
In several months of systematic occupations it is possible to include exercises in a sitting position and standing, carrying out transition from a prone position (at first in a sitting position, and then in a standing position), smoothly, by means of hands of the methodologist. Duration of occupations is gradually led up up to 10 — 20 min. then recommend rubdown by a cool and cold water or a shower with the subsequent grinding of a body a towel. It is desirable to continue self-massage of muscles of a stomach also. The physical exercises causing the shift of abdominal organs down (jumps, run, exercises with a natuzhivaniye, sharp inclinations of a trunk), are excluded.
At S.'s complications (unions, excesses and torsions of hollow bodies with the phenomena of partial or their full obstruction, disturbance of blood circulation in the displaced bodies, etc.) an operative measure is shown. Operation of a podshivaniye of bodies — a splankhnopeksiya (e.g., a hepatopexy, a nephropexy, a splenopexia, etc.) in a crust, time is made seldom in connection with small efficiency.
Forecast for life at uncomplicated S. favorable. At the complicated S. the forecast depends on character of a complication.
Prevention The page at children of an asthenic constitution consists in a balanced diet for the purpose of maintenance of normal body weight, systematic occupations of LFK for strengthening of a muscular and nervous system. Adults need to prevent bystry and excessive weight loss. To women, especially in recent months pregnancies and after the delivery, are recommended occupations of LFK and other actions for strengthening of a prelum abdominale, at indications — carrying an individual bandage.
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I. B. Rozanov; V. I. Illarionov (sport.), A. N. Kishkovsky (rents.).