A diverticulum is a bag-like protrusion of the intestinal wall, limited on both sides. Colonic diverticulosis is a disease that is 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 in 1769. And in 1853, the symptoms of this disease were described in detail.
According to statistics from the World Health Organization, diverticulosis of the colon occurs in 17 people per 100 thousand of the population. Single diverticulums are determined on average in 30% of people during x-ray examination. In most cases, there are no clinical manifestations, and the find is completely random.
Women are more susceptible to this pathology than men. In the representatives of the beautiful half, this diagnosis is made 1.5-2 times more often.
If we talk about age, then diverticulosis is mainly observed in people 50-60 years old.
The ICD-10 colon diverticulosis code is K57.
Causes of the disease
Diverticulosis of the left parts of the colon, as well as the right, belongs to the group of polyetiological diseases. This means that its cause is not exactly established. But scientists have developed several theories of the origin of this pathology:
- hereditary;
- mechanical: pulsion and hernia;
- mesenchymal;
- vascular.
In favor of a hereditary theory is the presence of diverticulosis in newborns. But the most common is hernia 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 protrusion of the intestinal wall may be associated with impaired contractility of its smooth muscles. This is due to disruption of the nerve plexuses located in the thickness of the wall. Muscle spasm and increased pressure in certain parts of the intestinal wall. Where vessels enter the intestinal wall, the mucous membrane protrudes.
What is a diverticulum?
As already noted above, a diverticulum is a protrusion of the intestinal wall on a limited surface. Such diverticulums are called hollow, or marginal. Through the neck with a diameter of up to 1 cm they are connected to the lumen of the intestinal tube.
There are also protrusions inside the layers of the intestinal wall, which are not connected to the lumen of the organ. They are called incomplete, or delaminating.
As soon as the protrusion appeared, the intestinal wall is in a normal condition. But over time, the mucous membrane is damaged, bleeding and perforation occur (rupture of the intestinal wall).
Most often, diverticulosis of the sigmoid and descending colon develops, that is, the terminal sections of the large intestine are affected.
Classification
Depending on the clinical manifestations, these 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, may 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 the loops of the intestine or intestines and neighboring organs;
- obstruction - a violation of the passage of intestinal contents.
Clinical manifestations
Most often, the symptoms of colon diverticulosis include impaired intestinal motor-evacuation function and pain.
The pain bothers the patient constantly, intensifying during meals, constipation. Pain relief occurs after bowel movement. The localization of unpleasant symptoms depends on the site of diverticulosis. So, with diverticulosis of the left colon, the pain is localized in the left ileal cavity. If the right sections are affected, soreness in the right iliac region is characteristic.
Violation of intestinal motility is expressed either by constipation or diarrheal syndrome. Nausea and vomiting are also possible.
In 1% of cases, patients with diverticulosis develop gallstones and diaphragmatic hernia, which is called the Triad of Seit. 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 option develops with a sluggish course. It is manifested by severe pain in the left iliac region, high body temperature, deterioration of overall well-being.
In a general blood test in such a patient, an increase in the number of leukocytes (leukocytosis) is observed mainly due to neutrophils, and an increase in the erythrocyte sedimentation rate. In a biochemical blood test, an increase in the level of C-reactive protein is noted. All these results indicate the presence of an active inflammatory process.
On palpation, the surgeon feels a seal in the area of the projection of the colon. If timely treatment is not carried out, the infiltrate suppurates and an abscess occurs. If an abscess breaks through, a serious complication called peritonitis will occur.
There are several options for the course of diverticulitis:
- latent;
- with abdominal crises;
- stab-like.
The latent form is characterized by an almost complete absence of clinical manifestations. Periodic short-term abdominal pain, defecation disorder are possible.
The variant with abdominal crises is characterized by a wave-like course. Asymptomatic periods alternate with pronounced manifestations: severe abdominal pain, which is first local 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 constant abdominal pain, diarrhea, or constipation. Body temperature may be elevated. In the feces, impurities of mucus and blood appear.
Clinic of other complications of diverticulosis
Perforation of the intestinal wall develops in almost 40% of patients with colon diverticulosis. Symptoms of perforation are very pronounced. There is a sharp pain in the abdomen, which patients compare with the blow of a dagger. The general condition is serious. 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 with signs of anemia is possible: pallor, slow heartbeat, low blood pressure, constant weakness and fatigue. With diverticulosis of the distal colon , bright red blood in the stool is noted.
Bowel obstruction occurs in about 10% of cases. Most often, it is associated with overlapping intestinal lumen formed "pseudotumor". Signs of obstruction - fecal retention, abdominal pain.
The following complications develop somewhat less frequently:
- purulent inflammation of the veins - phlebitis;
- abscesses of internal organs;
- sepsis;
- torsion of the legs of the diverticulum, which leads to ischemia and the death of the intestinal tract.
Methods for diagnosing the disease
When diagnosing diverticulosis of the colon, the surgeon first 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 of palpation, percussion (tapping) and auscultation (listening) of the intestine. Soreness on palpation, the presence of a seal can prompt the surgeon to the correct diagnosis.
Only after a detailed interview of the patient and an objective examination does the doctor give additional diagnostic methods. These include:
- general and biochemical blood tests;
- irrigography - x-ray examination of the intestine;
- ultrasound examination (ultrasound) of the abdominal cavity;
- computed tomography - 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 intestine using irrigography involves the introduction of contrast into the colon - barium sulfate. A contrast medium fills the intestinal tube, and it is clearly visible on x-rays. The diverticulum in this case looks like a protrusion of a round or oval wall. 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. Bulges without changes are perfectly emptied, the contrast quickly leaves them. And with diverticulitis, barium is delayed in protrusions and comes out with difficulty.
Sigmoidoscopy and colonoscopy - endoscopic examination methods. Their essence is the introduction of the chamber into the large intestine. In the image that is displayed on the monitor, you can see the diverticulum itself, determine the source of bleeding, and conduct differential diagnosis with other diseases.
Computed tomography is not used as often as irrigography and endoscopy. She is consulted in acute situations when it is necessary to quickly assess the condition of the intestine and decide on surgical intervention.
Ultrasound examination is uninformative in the diagnosis of diverticulosis, but may help in the differential diagnosis with other intestinal diseases.
Treatment methods
Treatment of diverticulosis of the colon includes several stages:
- diet;
- drug therapy;
- surgical intervention.
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 fruits and vegetables in the diet:
- cabbage;
- cucumbers
- Tomatoes
- flax seeds;
- bran;
- whole wheat 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 motility: seaweed, plantain seeds. For this purpose, medicines are also prescribed: Mukofalk, Gutalaks, Sterkulin.
In the preparation of a diet for diverticulosis of the colon in patients with diarrhea, foods rich in fiber should be limited to the maximum. They are also prescribed medicines with an astringent: Smecta, Carolen.
Drug therapy
Symptoms and treatment of diverticulosis of the colon with medicines are inextricably linked. The main purpose of prescribing is to eliminate the symptoms and alleviate the condition of the patient. Radical getting rid of the cause of the disease - protrusion in the intestinal wall - is impossible with the help of drugs alone.
The following drugs are included in the complex of drug therapy:
- antispasmodics - "Drotaverin", "Papaverine" - eliminate bowel 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 necessarily include vitamins B1, B6 and B12;
- sedatives - a decoction of valerian - with the patient's anxiety;
- physiotherapy and physiotherapy exercises.
In severe diverticulosis, the patient is hospitalized in a hospital. He is compensated for fluid deficiency by means of infusions of saline solutions, detoxification is carried out. The first 3 days, the patient eats parenterally through infusion of glucose and albumin solutions.
Surgery
Treatment of diverticulosis of the colon with surgery allows you to eliminate the pathology itself - digestion in the intestine. The operation is done with the ineffectiveness of drug therapy. In addition, it is indicated in the following cases:
- diverticulosis complicated by massive bleeding that cannot be stopped with medication;
- perforation of the intestinal wall;
- the formation of an abscess in the intestinal wall or in the internal organs of the abdominal cavity;
- bowel obstruction;
- formation of fistulous passages;
- malignant degeneration of the diverticulum.
Currently, surgeons are increasingly operating on uncomplicated diverticulosis, as this is accompanied by less mortality.
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 considered to be resection (removal) of the changed part of the colon: hemicolectomy or resection of the sigmoid colon. After this, the ends of the intestine are sutured, and the passage of contents in the intestine is restored.
Reviews
Patients diagnosed with diverticulosis disease noted that for a long time the symptoms were minor. Worried only periodical constipation or diarrhea. But over time, the condition worsened, and then they turned for help. In most cases, conservative treatment has helped. Only in neglected cases, when the patient did not seek medical help on time, an operation was needed.