Diverticulosis of the intestine

Diverticulosis of the intestine is a pathology more typical of age contingent after 50 years. The essence of the changes is the appearance of multiple protrusions of the weak intestinal wall outside. In half of the cases it is asymptomatic, it is detected by chance.

The main symptoms are associated with the inflammatory process( diverticulitis) and prolonged constipation. In medicine, the term "diverticular disease" has been adopted for a more complete display of possible manifestations, variants of the course and complications.

Prevalence of the pathology of

Statistics show an increase in the prevalence of the disease among the adult population, depending on the age: if up to 50 years diverticulosis of the intestine is detected in 5% of the examined, then in the 50-70 years, already every third, and among the older age group -.

Pathology becomes a typical age-related disease. This is especially true of the population of developed countries with ever-increasing longevity. Differences in the incidence of men and women do not. In 3% of cases, congenital diverticula are found in children under 10 years old.

Features of localization and structure

Diverticula can form in any part of the intestine, but the frequency is maximum in the sigmoid colon( 70%).This is associated with a significant load, the presence of bends contributing to stasis stool, narrowed diameter compared with the overlying areas of the large intestine.

The sigmoid colon functions as an accumulation, with the greatest internal pressure

. Diverticulosis of the small intestine and rectum is much less common. Thus, the frequency of detection of the diverticulum of Meckel( iliac department) varies among different authors from 1 to 4%.In 3% of patients there is a combined defeat of the duodenum, lean and iliac.

The diverticulosis of the large intestine, except for the sigmoid region, extends to the entire descending part. Formations can be single or multiple, of different sizes. Usually, the bulging in the outer side is from 3 to 30 mm. Large( giant) diverticula are rare. The cases of detection of single structures with a diameter of up to 15 cm are described.

A special feature of diverticula is an indispensable connection with the cavity of the gut. Depending on the structure of the wall distinguish:

• true - diverticulum is formed due to all layers of the intestinal wall;
• false - formed by the type of hernia by penetrating through the muscle layer only the inner epithelium.

Why do diverticulums arise?

The prevalence of pathology confirms the hypotheses of scientists about the direct effect on the development of diverticulosis:

• of senile muscle atrophy, disruption of intestinal wall feeding due to atherosclerosis of mesentery vessels;
• nature of nutrition - refers to the lack of plant products, in countries where less meat and nutrition is the basis of vegetarian( the food constantly contains enough fiber) diverticulosis of the intestine is less developed.

To contributing factors include:

• frequent intestinal infections;
• obesity;
• constipation and flatulence;
• prolonged intake of laxatives;
• elderly age with impaired microcirculation of blood supplying the intestinal wall;
• hereditary predisposition - weakness of connective tissue is due to inadequate synthesis of collagen and elastin in metabolic disorders, abnormalities of intestinal formation in the embryonic period.

Wall protrusion causes an increase in internal pressure in the intestinal cavity, pushing outward and stretching all layers. As a result, "pockets" or saccular cavities are formed, connected by a narrow isthmus with the intestine.

Pathology Forms

Depending on the causes of diverticulosis divide into congenital - is due to hereditary and embryonic disorders, acquired - arises from the transferred diseases, the presence of risk factors.

According to the clinical course, it is customary to isolate forms:

• is asymptomatic - typical for half the cases;
• with clinical signs - the symptoms of diverticulosis of the intestine are more or less pronounced;
• complicated. Doctors-gastroenterologists distinguish forms according to the clinical course of diverticulitis of the large intestine:
  • acute( 10-25% of all cases) - begins with sudden pain in the abdomen, a sharp rise in temperature, nausea, vomiting on the background of diarrhea orconstipation;
  • subacute - the symptoms are not so pronounced, but the pain remains, periods of temperature increase are unstable, diarrhea and constipation persist;
  • "smoldering" form - received the name, if with a confirmed diagnosis and a course of treatment up to a year there are moderate manifestations;
  • relapsing - the indicator of ill-being after the removal of the diverticulum by surgical means, complicates every tenth case of the operation.

  What are the symptoms of pathology?

  Diverticulosis in the intestine begins to appear only if the formations grow to significant size or become inflamed. Symptoms of diverticulitis with chronic course are especially often revealed when examining elderly people. The disease can not be ruled out with suspicion of any pathology in the abdomen. Of the clinical signs, most often patients complain of abdominal pain. They have the character of bursting, cramping colic.

  Localization of inflamed diverticula can be assumed locally:

  • on the left in the ileum region - the diverticulitis of the sigmoid region is manifested;
  • to the left of the navel - gives pain to the diverticulitis of the descending colon and the left half of the transverse-colon;
  • on the right in the ileum - inflammation of the diverticula of the blind and ileum( Meckel), it is almost impossible to distinguish from appendicitis, it is confirmed only during the operation with the allocation of unchanged vermicular appendix.

  How long the patient has an asymptomatic period depends on nutrition. If a person consumes enough vegetables and fruits, exercises, controls the daily compulsory drinking of water, then diverticulitis does not arise. The healthy intestine is cleaned and independently provides fight against pathogenic microorganisms.

  When the immunity decreases, changes in the nature of nutrition, involuntary immobility( chronic diseases, stroke), there are signs of uncomplicated form of diverticulitis: a disorder of the stool( diarrhea alternates with constipation), intestinal colic, a constant feeling of bloating and abdominal distension( flatulence), pains worse after eating andpass as a result of emptying and the escape of gases from the intestine.

  Patients complain of a feeling of incomplete bowel movement. It is believed that diverticulitis occurs in 10-20% of people suffering from diverticulosis.

  The severity of inflammation is judged:

  • by temperature increase;
  • increase in signs of intoxication( loss of appetite, weakness, nausea, vomiting, headache);
  • appearance of abundant mucus in the feces;
  • heartbeat;
  • increased pain sensitivity for palpation of the abdomen, similar symptoms of local peritonitis.

  In 10-15% of patients, the first symptom of diverticulitis is painless bleeding. It is caused by the erosion of an adjacent vessel or by trauma to a stiff stone stuck in the diverticulum.

  
  For colonoscopy, diverticula appear as multiple indentations in the intestinal wall of the

  Diagnostic features of the

  The diverticulosis of the intestine is revealed by auxiliary research methods. For this apply:

  • sight tomography images on the background of irrigoscopy - the procedure consists in introducing into the intestine an enema of barium suspension, filling the cavity and isolating contours of protrusions resembling hernial ones;
  • Colonoscopy - a visual examination of the large intestine with a thin tube with optics at the end, requires caution not to cause perforation of the wall, usually under anesthesia, is indicated for differential diagnosis with tumors;
  • Ultrasound - is carried out only after preparation( removal of the increased quantity of gases);
  • computed tomography is the most accurate method, it does not depend on the preparation of the patient;
  • scintigraphy - the use of a radioisotope preparation with labeled technetium, is carried out if necessary to distinguish from a tumor of the intestine.

  Intestinal diverticulitis is confirmed by changes:

  • in the blood test - leukocytosis, pronounced shift of the formula to the left with purulent complications, acceleration of the ESR;
  • in the coprogram - with diarrhea undigested remnants of food, a lot of mucus, white blood cells, pus, red blood cells;
  • is a positive stool test for Gregersen's reaction( latent blood).
  
  Colonoscopy helps to identify the source of bleeding

  What is the difference between diverticulosis in the small intestine?

  The small intestine is considered a rare localization of diverticula, but pathology can not be ruled out in the differential diagnosis of diseases of the stomach, duodenum, bile excretory system. The most common lesion is the duodenum and jejunum.

  Acidic contents enter the internal cavity of the diverticulum from the stomach. In the border area, the erosion and ulceration of the mucosa is rapidly developing. If the diverticulum is located in the lower part of the duodenum, the inflammation passes to the bile ducts, the pancreas.

  Symptoms are accompanied by:

  • cramping pains in the right hypochondrium and epigastrium, very similar to the hypertonic form of bile duct dyskinesia, calculous cholecystitis, pancreatitis;
  • squeezing the sphincter zone of Oddi with a large diverticulum leads to mechanical jaundice, impaired pancreatic function( liquid fatty stool, protein loss, shingles).
  As the inflammation spreads by contact gradually, favorable conditions for the development of chronic cholecystopancreatitis are created.

  Complications of diverticulitis

  Unpatched inflammation of the diverticulum does not pass by itself. Accession of pathogenic putrefactive bacteria causes the formation of:

  • of local abscesses with the penetration of infection into the cavity of the diverticulum, inflammation in the surrounding cellulose;
  • diffuse intestinal phlegmon;
  • perforation of the thinned wall and exit of the contents into the cavity of the peritoneum, peritonitis( fecal spilled peritonitis occurs with necrosis and rupture of the intestinal wall, except for signs of irritation of the peritoneum, accompanied by severe toxic shock);
  • "corrosive" vessels and intestinal bleeding, can stop on its own, but in patients with hypertension, atherosclerosis, blood loss reaches a significant volume;
  • fistula formation in the bladder( colovesical), pyelonephritis, cystitis, impaired urination, the appearance of fistula outflows in the form of intestinal dermal fistulas;
  • compression of the intestine by a large diverticulum, a common infiltrate, spikes can cause an obstruction of the intestine, clinically it manifests itself by bloating above the zone of obstruction, sharp pains, stool and gas retention.

  Each aggravation ends with the formation of scars and adhesions, which narrow the lumen of the intestine.

  
  As a result of complications, the morphological structure of the tissue changes with the growth of polyps, a cancerous tumor

  Treatment of diverticulosis of the intestine

  If the patient does not have symptoms when there is a diverticulosis, no special treatment is required. It is important to prevent inflammation( diverticulitis).For this, it is necessary to monitor regular cleansing of the intestine, to prevent constipation. Such patients are recommended by doctors for diet. It is proper nutrition that can support bowel function.

  To do this, you should drink at least 1.5 liters of water a day, introduce vegetables and fruits rich in fiber into the diet, be sure to consume sour-milk products. It is necessary to exclude fried, pickled, smoked meat and vegetable dishes, legumes and mushrooms, limit baking, culinary products, fatty meat, drink a decoction of dried apricots, prunes and steamed fruits, herbal laxative teas.

  Treatment of diverticulosis of the large intestine

  In some cases, drugs that reduce gassing, improving the intestinal flora( probiotics and prebiotics) are recommended to normalize the stool.

  Laxatives should be avoided because they increase internal intestinal pressure. Patients with signs of inflammation and bleeding need bed rest. Antibiotics and sulfanilamide preparations with predominant absorption in the intestine are prescribed.

  Diverticular bleeding stops ¾ of the cases on its own. With a colonoscopy, it is possible to simultaneously inject Vasopressin into the nearest artery to 90% of patients to stop bleeding. The method is called angiographic embolization of the vessel. Negative effect - intestinal infarction( 20% of cases).Therefore, laser and thermocoagulation are more often used.

  For the removal of spastic abbreviations Mebeverin, anesthetics are shown. If the diverticulum is located in the area of ​​the duodenum, then enzymes of the pancreas may be needed. To combat intoxication, intravenously injected solutions of salts and glucose. For 5% of patients with severe bleeding may require blood substitutes.

  Who is indicated for surgical treatment?

  The acute form of diverticulitis is always a danger in terms of perforation of the intestinal wall with the development of peritonitis. Therefore, it is necessary to determine the indications for surgical intervention.

  Usually, the operation is offered in the following cases:

  • of 1-2 exacerbations and unsuccessful conservative treatment;
  • massive bleeding, the inability to establish a source and dispense with local procedures;
  • symptoms of intestinal obstruction;
  • diffuse phlegmon, peritonitis of retroperitoneal space;
  • breakthrough abscess;
  • presence of external or internal intestinal fistula.

  In each case, the individual volume of surgical intervention is determined. Often resection is combined with myotomy( muscle dissection) to reduce intestinal pressure.

  
  During the operation, it is necessary to remove the intestine site affected by diverticula, to connect the remaining ends of the

  with the anastomosis. Forecast

  The success of conservative therapy depends on the degree of neglect of the process. In the complex treatment of the first attack, it is possible to achieve a positive effect in 70% of cases. If the patient has a third exacerbation, only 6%.It is shown that the use of diet in uncomplicated cases allows to improve the course and prevent complications in 10% of patients.

  With bleeding, eliminated in various ways, relapse occurs in 20-30% of cases. Surgical treatments reduce the risk of life-threatening complications. When identifying asymptomatic diverticulosis of the intestine, it is necessary to follow all the doctor's advice for the prevention of diverticulitis and possible complications.