Visceroptosis is a downward displacement of abdominal organs, primarily intestinal loops, compared to their normal anatomical location. The condition is manifested by chronic constipation, pain in various parts of the abdomen, which are intensified in the standing position. To diagnose enteroptosis, the Glenard test and instrumental techniques are used — irrigation, ultrasound of the abdominal cavity, colonoscopy and scintigraphy. Conservative treatment includes diet therapy, exercise therapy and wearing a bandage. In complicated forms of visceroptosis, surgical intervention is indicated.
ICD 10
K63.4 Enteroptosis
Meaning
Visceroptosis has several synonyms — enteroptosis, splanchnoptosis, Glenar syndrome. The true frequency of the disease is unknown, since only about 10-20% of cases of visceroptosis manifest clinically. Most pathologies are found by chance when contacting about other symptoms. There are 2 peaks of detection of enteroptosis: at a young age and in the elderly (60-65 years). Women suffer from abdominal organ prolapse 3 times more often than men. In children, visceroptosis is very rare, more often associated with congenital malformations.
Causes of visceroptosis
The exact etiological factors of visceroptosis are unknown. Some scientists believe that the pathological mobility of the abdominal organs and their omission is a constitutional variant of the norm in cases where they are not accompanied by clinical signs. A more common theory is that visceroptosis occurs when a complex of stabilizing factors is violated. In modern gastroenterology , there are 3 groups of causes of enteroptosis:
- Weakness of connective tissue. The normal position of the organs is achieved thanks to the ligamentous apparatus of the abdominal cavity. Due to connective tissue dysplasia, these ligaments and fascia are underdeveloped. The causes of visceroptosis are Marfan syndrome, Ehlers-Danlos syndrome.
- Rapid weight loss. With a sharp weight loss, there is a loss of fatty tissue located in the abdominal cavity and retroperitoneal space. As a result, all mobile organs begin to shift downward, which is aggravated by a person’s predisposition to anatomical visceroptosis.
- Overstretching of the abdominal muscles. This reason is associated with particular cases of enteroptosis in women who have given birth many times, in whom the rectus and oblique abdominal muscles overgrow and become atrophic. The risk of visceroptosis increases after large ventral hernias, recurrent ascites.
Pathogenesis
Most often, with visceroptosis, there is a lesion of the colon, which is the most mobile. The transverse colon becomes U-shaped, which makes it difficult for food and gases to pass through. Violation of passage through the gastrointestinal tract is the main pathophysiological mechanism that causes the appearance of symptoms. With the prolonged existence of enteroptosis, intestinal adhesions and deformities occur.
Histologically, long-term visceroptosis is a catarrhal inflammation and atrophy of individual sections of the intestinal wall. Infiltration of the submucosa occurs, with a chronic inflammatory process, fibrous changes are added. Enteroptosis is characterized by the gradual death of intramural nerve ganglia, which provokes pathological overgrowth of the intestineV
Visceroptosis symptoms
Omission of certain parts of the colon is manifested by various clinical symptoms. Visceroptosis of the hepatic or splenic bend of the colon is most often diagnosed, the main symptom of which is constipation. A person feels heaviness in the abdomen and pain localized in the umbilical region. Worries about constant bloating of the intestine. Symptoms worsen in an upright position.
With visceroptosis of the cecum, all of the above signs are localized in the right iliac region. Attacks of sharp pains are characteristic, which resemble the clinic of acute appendicitis. With enteroptosis of the sigmoid colon, constipation alternates with diarrhea, mucus and blood inclusions are usually observed in the stool. Patients complain of sharp cramping pains in the left iliac region.
There is a deformation and sagging of the abdomen, which increases when the trunk is tilted forward. White stretch marks appear on the skin of the abdominal wall. With visceroptosis, patients experience discomfort during prolonged walking without a bandage, when working in an inclined position. Diastasis is often determined — the divergence of the rectus abdominis muscles, which can be visually noticed or felt.
Long-term visceroptosis leads to chronic constipation. At first, patients have no stool for several days, in some cases, self-defecation is possible. As the process progresses, constipation lasts up to 10 days or more, fecal masses come out only after enema. As a result of endogenous intoxication, weakness, dizziness, nervousness appear.
Complications
Visceroptosis is often combined with stretching and elongation of the intestine, which increases the risk of intussusception and intestinal inversion. These conditions are dangerous, because if medical care is not provided, ischemia and tissue necrosis are observed. A frequent complication of enteroptosis is the syndrome of the superior mesenteric artery, accompanied by ischemic intestinal necrosis.
Experts note that the disease serves as an independent risk factor for chronic colitis and enteritis. Visceroptosis, occurring against the background of chronic colonic stasis, causes reflux esophagitis in 66% of cases. Duodenal obstruction occurs in 15% of patients. Enteroptosis is often associated with gastroptosis (39%), nephroptosis (17.8%), hepatoptosis (5%).
Diagnostics of visceroptosis
Examination of patients with suspected visceroptosis is carried out by a gastroenterologist. There are no pathognomonic manifestations during physical examination. It is possible to assume the presence of enteroptosis with a positive Glenard test. Instrumental methods of intestinal visualization are crucial in the diagnosis of the disease:
- Abdominal ultrasound. Sonography is a primary diagnostic study that shows violations of anatomical relationships between the organs of the abdominal cavity. Ultrasound is informative for detecting associated pathology, complications of enteroptosis.
- Irrigation. X—ray examination of the intestine with contrast is the most informative method for detecting visceroptosis. Contrasting reveals the omission of the intestine, the expansion of some of its departments. With the help of delayed images, the speed of passage through the intestine is checked.
- Scintigraphy. The radionuclide method of diagnosing enteroptosis is carried out to establish early functional abnormalities in the work of the digestive organs. Scintigraphy is more informative than other methods of instrumental diagnostics, and also reduces the radiation load on the patient.
- Colonoscopy. Endoscopic examination is an auxiliary diagnostic technique used to assess the condition of the mucous layer of the colonic membrane. The study is used for the differential diagnosis of visceroptosis if the patient has complaints of mucus and blood in the feces.
Treatment for visceroptosis
Conservative therapy
The main method of treatment of visceroptosis is non-drug methods. The patient is selected a special diet with fractional nutrition, increased fiber and fluid content. Changing the diet is aimed at activating intestinal motility, reducing the risk of constipation. With pronounced omission of organs, a special bandage is selected, when worn, unpleasant symptoms decrease.
Non-drug methods of enteroptosis therapy include special exercise therapy complexes that are aimed at strengthening the muscles of the anterior abdominal wall. Medications are prescribed much less frequently. For chronic constipation, mild laxatives, oil enemas are used. If inflammatory complications are detected, the treatment regimen is selected individually.
Surgical treatment
In the sub- and decompensated stages of visceroptosis, abdominal surgeons determine indications for surgical intervention. In recent years, surgical techniques have improved significantly, so good long-term results are observed in 93-95% of patients. Usually, various options for colon resection with the imposition of anastomoses are used.
Prognosis and prevention
In most cases, visceroptosis does not pose a threat to life and health, so doctors give a favorable prognosis. Even in the decompensated stage, it is possible to improve the well-being of patients with the help of modern surgical interventions. Prevention of the disease includes wearing bandages during pregnancy and after childbirth, exercises to strengthen the muscular framework of the abdomen.
Literature
- Surgical anatomy of the anterior abdominal wall in normal viscera, dolichoviscerosis and visceroptosis. Romanov PA, Koltoniuk VM. Arkh Anat Gistol Embriol. 1990 Nov;99(11):60-5. link
- Visceroptosis and the Ehlers-Danlos Syndrome. Kucera S, Sullivan SN. Cureus. 2017 Nov 8;9(11):e1828. link
- The clinical complexities of visceroptosis. JAFFE NB. Miss Valley Med J. 1956 Sep;78(5):226-8. link
- Visceroptosis of the bowel in the hypermobility type of Ehlers-Danlos syndrome: presentation of a rare manifestation and review of the literature. Reinstein E, Pimentel M, Pariani M, Nemec S, Sokol T, Rimoin DL. Eur J Med Genet. 2012 Oct;55(10):548-51 link
- Gastrointestinal involvement in the Ehlers-Danlos syndromes. Fikree A, Chelimsky G, Collins H, Kovacic K, Aziz Q. Am J Med Genet C Semin Med Genet. 2017 Mar;175(1):181-187. link