Diverticulum is a sac-like protrusion of the intestinal wall, limited on both sides. Diverticulosis of the colon is a disease characterized by the formation of multiple diverticula throughout the intestinal wall.
This article will discuss the causes, symptoms, methods of diagnosis and treatment of diverticulosis.
Historical background and statistics
The first publication about saccular protrusions on the intestinal wall was published back in 1769. And in 1853, the symptoms of this disease were described in detail.
According to statistics from the World He alth Organization, colonic diverticulosis occurs in 17 people per 100,000 people. Solitary diverticula are determined on average in 30% of people during x-ray examination. In most cases, there are no clinical manifestations, and the finding is completely random.
Women are more susceptible to this pathology than men. RepresentativesIn the beautiful half, this diagnosis is made 1.5-2 times more often.
In terms of age, diverticulosis is predominantly observed in people aged 50-60.
Colon diverticulosis code according to ICD-10 - K57.
Causes of disease
Diverticulosis of the left colon, as well as the right, belongs to the group of polyetiological diseases. This means that its cause has not been precisely established. But scientists have developed several theories of the origin of this pathology:
- hereditary;
- mechanical: pulsation and hernial;
- mesenchymal;
- vascular.
In favor of the hereditary theory is the presence of diverticulosis in newborns. But the most widespread hernial theory. In this case, the formation of diverticula is associated with a weakening of the connective fibers in the intestinal wall, as well as an increase in pressure in the abdominal cavity.
Later it was found that the protrusion of the intestinal wall may be associated with impaired contractility of its smooth muscles. This is due to a malfunction of the nerve plexuses located in the thickness of the wall. There is muscle spasm and increased pressure in certain parts of the intestinal wall. Where the vessels enter the intestinal wall, the mucosa protrudes.
What is a diverticulum?
As noted above, a diverticulum is a protrusion of the intestinal wall on a limited surface. Such diverticula are called hollow, or marginal. Through a neck up to 1 cm in diameter, they are connected tolumen of the intestinal tube.
There are also protrusions within the layers of the intestinal wall that are not connected to the lumen of the organ. They are called incomplete, or stratifying.
As soon as the protrusion appears, the intestinal wall is in a normal state. But over time, the mucous membrane is damaged, bleeding and perforation (rupture of the intestinal wall) occur.
Most often, diverticulosis develops in the sigmoid and descending colon, that is, the terminal sections of the large intestine are affected.
Classification
Depending on the clinical manifestations, the following forms of the disease are distinguished:
- asymptomatic;
- with severe symptoms or uncomplicated diverticular disease;
- with the development of complications.
Diverticulosis of the colon can lead to the following undesirable consequences:
- diverticulitis - inflammation of the protrusion of the intestine, can have an acute and chronic course;
- perforation - perforation of the intestinal wall or directly into the abdominal cavity, or covered;
- cancer - malignancy of the diverticulum;
- bleeding;
- fistulas - the formation of a passage between intestinal loops or intestines and neighboring organs;
- obstruction - violation of the passage of intestinal contents.
Clinical manifestations
The most common symptoms of colonic diverticulosis include impaired motor-evacuation function of the intestine and pain.
Pain worries the patient constantly, intensifyingduring meals, constipation. Pain relief occurs after defecation. Localization of unpleasant symptoms depends on the location of diverticulosis. So, with diverticulosis of the left colon, pain is localized in the left iliac cavity. If the right sections are affected, pain in the right iliac region is characteristic.
Impaired intestinal motility is expressed either by constipation or diarrheal syndrome. Nausea and vomiting may also occur.
In 1% of cases, patients with diverticulosis develop gallstones and a diaphragmatic hernia, which is called Seit's triad. In this case, the clinical picture is more diverse.
Symptoms of diverticulitis
Such a complication of diverticulosis of the descending colon as diverticulitis develops in 30-90% of patients. It can be acute and chronic. Most often, the second variant develops with a sluggish course. It is manifested by severe pain in the left iliac region, high body temperature, deterioration in general well-being.
In the general blood test, such a patient has an increase in the number of leukocytes (leukocytosis), mainly due to neutrophils, an increase in the erythrocyte sedimentation rate. In the biochemical analysis of blood, an increase in the level of C-reactive protein is noted. All these results indicate the presence of an active inflammatory process.
During palpation, the surgeon feels the seal in the projection area of the colon. If timely treatment is not carried out, the infiltrate suppurates and an abscess occurs. If the abscess rupturesa severe complication called peritonitis will occur.
There are several options for the course of diverticulitis:
- latent;
- with abdominal crises;
- colitis-like.
The latent form is characterized by the almost complete absence of clinical manifestations. There may be periodic short-term pain in the abdomen, impaired defecation.
The variant with abdominal crises is characterized by an undulating course. Asymptomatic periods alternate with pronounced manifestations: severe abdominal pain, which is local at first, and then spreads to the entire abdomen, high body temperature, flatulence and diarrhea. In the feces, impurities of mucus, blood and pus are visible. On palpation, the intestine is sharply painful.
The colitis-like form is manifested by persistent abdominal pain, diarrhea or constipation. Body temperature may be elevated. Impurities of mucus and blood appear in the feces.
Clinic of other complications of diverticulosis
Perforation of the intestinal wall develops in almost 40% of patients with colonic diverticulosis. Symptoms of perforation are very pronounced. There is a sharp pain in the abdomen, which patients compare with a dagger. The general condition is severe. On palpation, the anterior abdominal wall is sharply painful and tense, the symptoms of peritoneal irritation are positive. This indicates inflammation of the peritoneum - peritonitis.
Bleeding is another common complication of diverticulosis. Most often it is insignificant and does not cause inconvenience to the patient. But massive blood loss is possible withsigns of anemia: pallor, slow heartbeat, low blood pressure, constant weakness and fatigue. In diverticulosis of the distal large intestine, there is bright red blood in the stool.
Intestinal obstruction occurs in about 10% of cases. Most often, it is associated with the overlapping of the intestinal lumen by the formed "pseudotumor". Signs of obstruction - retention of feces, abdominal pain.
The following complications develop somewhat less frequently:
- purulent inflammation of the veins - phlebitis;
- abscesses of internal organs;
- sepsis;
- torsion of the diverticulum pedicle, leading to ischemia and death of the intestine.
Methods of diagnosing the disease
When making a diagnosis of diverticulosis of the colon, the surgeon first of all conducts a detailed conversation with the patient. He should ask him about complaints, the development of manifestations in dynamics, the presence of concomitant diseases, and so on.
After the doctor conducts an objective examination. It consists in palpation, percussion (tapping) and auscultation (listening) of the intestine. Soreness on palpation, the presence of a seal can lead the surgeon to the correct diagnosis.
Only after a detailed questioning of the patient and an objective examination, the doctor gives direction to additional diagnostic methods. These include:
- general and biochemical blood tests;
- irigography - x-ray examination of the intestine;
- ultrasound examination (ultrasound) of organsabdomen;
- computed tomography is an X-ray method that allows you to determine the violation of the structure of internal organs with high accuracy;
- colonoscopy - endoscopic examination of the large intestine;
- sigmoidoscopy - endoscopic examination of the rectum.
Examination of the colon using irigography involves the introduction of contrast - barium sulfate - into the colon. The contrast agent fills the intestinal tube, and it is clearly visible on x-rays. The diverticulum in this case looks like a protrusion of the wall of a round or oval shape. It has a clear contour and a diameter of up to 1.5 cm. If the diverticulum is inflamed, its contours will be uneven, jagged. The protrusions are perfectly emptied without changes, the contrast quickly leaves them. And with diverticulitis, barium lingers in the protrusions and comes out with difficulty.
Sigmoidoscopy and colonoscopy - endoscopic examination methods. Their essence lies in the introduction of the camera into the large intestine. On the image displayed on the monitor, you can see the diverticulum itself, determine the source of bleeding, and make a differential diagnosis with other diseases.
Computed tomography is not used as often as irigography and endoscopy. They turn to her in acute situations when you need to quickly assess the condition of the intestine and make a decision on surgical intervention.
Ultrasound examination is not very informative in the diagnosis of diverticulosis, but may help in differential diagnosis with other bowel diseases.
Treatment methods
Treatment of colonic diverticulosis involves several steps:
- diet;
- drug therapy;
- surgery.
Dietary recommendations depend on the nature of the stool. If the patient suffers from constipation, the menu for diverticulosis of the colon should include as much fiber as possible. The patient should increase the amount of such vegetables and fruits in the diet:
- cabbage;
- cucumbers;
- tomatoes;
- flax seeds;
- bran;
- whole grain bread;
- peas;
- legumes;
- apples;
- citrus.
Patients with constipation are not recommended to consume whole milk, soda. It is worth including in the diet substances that irritate the intestinal receptors and stimulate peristalsis: sea kale, psyllium seeds. For this purpose, drugs are also prescribed: "Mukofalk", "Gutalax", "Sterkulin".
In formulating a diet for colonic diverticulosis in patients with diarrhea, fiber-rich foods should be limited as much as possible. They are also prescribed medicines with an astringent property: "Smekta", "Karolen".
Drug therapy
The symptoms and drug treatment of colonic diverticulosis are inextricably linked. The main purpose of prescribing drugs is to eliminate symptoms and alleviate the patient's condition. Radical getting rid of the cause of the disease - protrusions in the intestinal wall - is impossiblewith medication alone.
The complex of drug therapy includes the following drugs:
- antispasmodics - "Drotaverine", "Papaverine" - eliminate intestinal spasm and relieve pain;
- anticholinergics - "Atropine", "Platifillin" - have an effect similar to antispasmodics;
- antibiotics - "Ciprofloxacin", "Ampicillin", "Tetracycline" - for the prevention and treatment of infectious complications;
- multivitamin preparations, which must include vitamins B1, B6 and B12;
- sedatives - decoction of valerian - in case of anxiety of the patient;
- physiotherapy and exercise therapy.
In severe cases of diverticulosis, the patient is hospitalized in a hospital. He is replenished with fluid deficiency with the help of infusions of saline solutions, detoxification is carried out. For the first 3 days, the patient is fed parenterally through infusions of glucose and albumin solutions.
Surgical treatment
Treatment of diverticulosis of the colon with the help of surgery allows you to eliminate the pathology itself - bulging in the intestine. The operation is done with the ineffectiveness of drug thearpy. In addition, it is shown in the following cases:
- diverticulosis complicated by massive bleeding that cannot be controlled with medication;
- perforation of the intestinal wall;
- abscess formation in the intestinal wall or in internal organsabdomen;
- intestinal obstruction;
- formation of fistulous passages;
- malignant degeneration of the diverticulum.
Surgeons are now increasingly operating on uncomplicated diverticulosis as it has a lower mortality rate.
The type of surgical intervention is selected individually, depending on the severity of the pathology, the prevalence of diverticulosis, and the characteristics of the patient's body. The most effective operation for diverticulosis is the resection (removal) of the altered part of the colon: hemicolectomy or resection of the sigmoid colon. After that, the ends of the intestine are sutured, and the passage of the contents in the intestine is restored.
Reviews
Patients who have been diagnosed with diverticulosis report that symptoms have been mild for a long time. Worried only periodical constipation or diarrhea. But over time, the condition worsened, and then they turned for help. In most cases, conservative treatment helped. Only in advanced cases, when the patient did not seek medical help in time, an operation was needed.
