DIVERTICULE (Lat. diverticulum road to the side, deviation) - congenital or acquired protrusion of the wall of a hollow organ, communicating with its cavity.
The most frequent localization of D. is the digestive tract, less often they are found in the urinary and gall bladder, extrahepatic bile ducts, ureters, urethra and other hollow organs.
Etiology and pathogenesis
The reasons of occurrence of D. are various. The most studied in relation to etiology and pathogenesis are D. of the esophagus, stomach and intestines. It is established that D.'s localization often coincides with the area of occurrence of congenital malformations (anomalies) of the intestine - the place of transition of the embryonic anterior intestine to the posterior. In this connection, there is an opinion about the congenital underdevelopment of the muscular membrane of the intestinal wall, leading to the formation of D. in various periods of life. Confirmation of this concept is the presence of islands of a dystopian pancreas in the wall of D., the pyloric part of the stomach. All researchers believe that D.'s development is due to weakness of the intestinal wall, which arises not only in connection with the congenital inferiority of the muscle membrane, but also due to a decrease in muscle tone and loss of mechanical strength of the connective tissue framework during aging. In favor of this is an increase in the frequency of D. in older age groups. The preferential localization of D. at the mesenteric edge of the intestine is determined by the natural sparseness of the muscular elements of the intestinal wall in the zone of entry of numerous feeding vessels into it. Subcardial D. make up 70% of all D. stomach and are located in the anatomically weak zone - the subcardial section of the posterior wall, where the circular muscle layer does not overlap longitudinal. Significantly reduce the strength of the wall of the organ destructive-ulcerative processes.
Increased intestinal pressure, for example, due to constipation, enteroptosis, plays the role of a resolving factor in the development of protrusion of the intestinal wall. Such are the pulsion D. of the esophagus (Fig., 7), formed in connection with an increase in pressure in its cavity due to a violation of coordination between the act of pushing the food lump and the opening of the gastric sphincter. With the so-called. traction D. of the esophagus, along with an increase in intracavitary pressure, the extension of its walls outside by periesophageal cicatricial cords in the outcome of pharyngeal abscesses and mediastinitis is important (Fig., 2). By its pathogenesis, the majority of traction D. of the esophagus is actually combined traction-pulsion D. All the conditions mentioned play a role in the development of D. and other hollow organs, for example, the bladder.
D. are single and multiple. In casuistic observations, up to 400 diverticulums of various localization are found in one patient. In such cases, they speak of diverticulosis as a kind of systemic process.
D. can be of various shapes (spherical, cylindrical, oval, pear-shaped, saccular, etc.), ranging from barely noticeable protrusions to large formations 6-14 cm long and dia. 2-5 cm, with a wide or narrow inlet. The diameter of the hole D. depends on its shape and size: cylindrical, bag-shaped and pear-shaped D. are distinguished by a wide inlet. The small width of the inlet, observed, for example, in spherical D. (Fig., 3), significantly complicates the evacuation of the contents that entered it, which contributes to stone formation and the development of inflammatory processes.
According to histol, the wall structure is distinguished by true and false D. (Fig., 4 and 5). The true ones include D., formed due to all layers of the wall of a hollow organ. False D. is a hernia-like protrusion of the mucous membrane and submucosa through a defect in the external muscle layer of the wall, is covered externally with a serous membrane or fibrous tissue. D.'s division into true and false conditionally, because with D.'s prolonged existence, muscle elements in the bottom area can gradually atrophy. D.'s walls are deformed even more. The inflammatory processes observed in them. In these cases D.'s walls are often presented by scar tissue, and then it is difficult to distinguish true D. from false even with a microscopic examination. For the same reasons, the classification of true D. as congenital, and false as acquired, is unreasonable, because it is often impossible to prove whether one or another diverticulum formed in the embryogenesis stage or in the postnatal period. An exception to this is Meckel’s diverticulum (see Meckel’s diverticulum), which is the remainder of the embryonic umbilical tract.
D. can exist asymptomatically and be an accidental find during rentgenol, research or autopsy. In some cases, D. is accompanied by a disorder of the motor function of the organ. Stagnation in the D.'s cavity of contents rich in microbes contributes to the development of an inflammatory process in its wall - diverticulitis, which spreads to surrounding tissues (peridiverticulitis). Inflammation easily leads to ulceration and perforation of the thinned wall with the development of diffuse purulent inflammation of the surrounding fiber (see Pharyngeal abscess, Mediastinitis) or purulent peritonitis when D. is opened into the abdominal cavity (see Peritonitis). In the walls of Meckel’s diverticulum, it is often possible to find elements of a dystopian gastric mucosa that contribute to ulceration of the mucous membrane and bleeding, which is often observed in children. With a sharp increase in intracavitary pressure, the walls of D., e.g., the bladder, can rupture, which is accompanied by the formation of urinary leakage (see. Urinary leakage) and the occurrence of peritonitis. A rare complication is the development of malignant tumors in D. Of great importance in the diagnosis of D. is rentgenol, a study that makes it possible not only to establish its presence, but also to determine the degree of functional disorders present in it or caused by it.
The question of the treatment of D. arises, as a rule, only with the development of the concomitant patol process. Conservative treatment is indicated only during the first attack of acute diverticulitis. In all other cases, the treatment is prompt.
Forecast in the presence of uncomplicated D. favorable for life.
Bibliography: Multivolume Guide to Pathological Anatomy, ed. A.I. Strukova, vol. 4, pr. 1, p. 241, M., 1956, bibliogr., Sato E. a. about. Polyps and diverticulosis of large bowel in autopsy population of Akita prefecture, compared with Miyag, Cancer, v. 37, p. 1316, 1976, bibliogr.
See what a "false diverticulum" is in other dictionaries:
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What is a diverticulum? General information and types of neoplasms
For starters, you should familiarize yourself with the general information. As already mentioned, a diverticulum is a protrusion of the wall of a hollow or tubular organ. Despite the fact that such structures can form everywhere, in most cases digestive tract organs, namely the intestines, suffer from diverticulosis. Much less often, such protruding are formed from the walls of the bladder, urethra, trachea.
It is worth noting that this is a very common phenomenon. Approximately 50% of elderly patients have at least one bowel diverticulum. It is not dangerous in itself. Unfortunately, such protruding tissues are prone to inflammation, which entails a lot of complications.
Similar structures can be:
- Congenital (or true). The growth is formed in the process of fetal development and, as a rule, affects all layers of the intestinal wall),
- False (or acquired). They form with age and, as a rule, in those places where blood vessels enter the intestinal wall.
Most often, in modern medical practice, the diverticulum of the colon, namely the part that is called the sigmoid, is recorded.
The main causes of intestinal pathology
A diverticulum is a protrusion that can be formed both during fetal development and as the body grows older. Unfortunately, it is not always possible to find out the causes of the appearance of congenital diverticulums of the intestine. It is believed that there is a hereditary predisposition (a specific intestinal structure or connective tissue weakness is often transmitted to the child).
If we are talking about acquired abnormal structures and their further inflammation, then several risk factors can be distinguished:
- First of all, it is worth talking about the wrong diet, in particular, fiber deficiency. It is dietary fiber that stimulates intestinal motility. Against the background of insufficient fiber intake, food movement in the intestines slows down. Feces become drier and harder, resulting in increased pressure in the lumen of the digestive tract. Such processes often lead to the appearance and further inflammation of diverticula.
- Diverticulitis can provoke other inflammatory diseases of the large intestine, including various infections, ulcerative, ischemic and spastic colitis. Even with proper therapy, pathogenic microorganisms can remain in the tissues of the diverticulum, as a result of which an inflammatory process develops.
- Risk factors include age. The fact is that as the body ages, the intestinal mucosa becomes thinner, peristalsis weakens, chronic constipation develops. That is why intestinal diverticulum is more likely to form in an elderly patient. In this period of life, the risk of inflammation increases.
- The inflammatory process can be triggered by the activity of worms. Against the background of invasion by these parasites, dysbiosis develops. The weakening of the immune system creates excellent conditions for the development of pathogenic bacteria, which most often settle on the surface of the diverticulum.
Intestinal diverticulosis: what are the symptoms?
The diverticulum itself does not cause any serious violations - a person feels quite normal. But, as already mentioned, such protrusions are often inflamed, and this already entails the appearance of very characteristic symptoms:
- The main symptom is pain. Pain is most often localized in the lower left abdomen. Soreness is monotonous and does not disappear within a few days. The patient's condition worsens with tension of the abdominal wall (for example, with coughing, laughing, physical exertion). The pain does not go away even after defecation.
- Diverticulitis is characterized by stool disorders. Against the background of inflammation, a spasm of the intestinal wall is often observed, as a result of which constipation appears. After the wall relaxes and expands, patients are faced with a problem such as diarrhea.
- Inflammation of the diverticulum is often accompanied by damage to blood vessels and the appearance of ulcers. That is why traces of blood often appear in the feces of a sick person. In the most severe cases, the inflamed diverticulum ruptures, which is accompanied by severe pain and bleeding from the intestines.
- Since this is an inflammatory process, one cannot but mention the symptoms of intoxication of the body. Patients complain of fever, decreased appetite, nausea, lethargy, weakness, chills, body aches.
A diverticulum of the sigmoid or colon (as well as any other organ) is rarely accompanied by any specific symptoms, so it can only be detected during a routine examination.
However, with inflammation of this structure, patients complain of abdominal pain and other problems. In such cases, the doctor must collect a complete history, after which he conducts a general examination and palpation. Additionally, analyzes are carried out. For example, during a laboratory blood test, an increase in the number of white blood cells can be detected, which confirms the presence of an inflammatory process.
Instrumental diagnosis for intestinal diverticulitis
Laboratory studies can confirm the presence of an inflammatory process. But a diagnosis such as diverticulitis can be made only after a thorough instrumental diagnosis, which includes the following procedures:
- Perhaps the most informative research method is colonoscopy. During the procedure, the doctor with the help of an endoscope carefully examines the inner surface of the colon. The procedure allows you to detect diverticula, determine their exact number and location, carefully examine the condition of the mucous membrane.
- If during the colonoscopy it was not possible to obtain accurate results, the patient is sent for an X-ray examination of the intestine. In the picture, the doctor can see a protrusion that goes beyond the contour of the intestine - this is diverticulum.
- Sometimes an additional ultrasound of the abdominal cavity is performed, which also makes it possible to assess the condition of the intestine and detect the presence of protrusions, neoplasms and other pathologies.
Therapy in this case depends on the condition of the patient, the number of diverticula, the presence of inflammation and ulcers. As a rule, the treatment regimen includes the following medications:
- In the presence of an inflammatory process, doctors, as a rule, prescribe antibiotics of a wide spectrum of effects to patients. Effective in this case are drugs such as Timentin and Cefoxitin. These drugs have a detrimental effect on the walls of bacteria, with the activity of which inflammation of diverticula is associated.
- Anti-inflammatory drugs are also effective, helping to get rid of the main symptoms of inflammation.Drugs such as Salofalk and Mesalazine are often included in the treatment regimen.
- Antihistamines, in particular Tavegil and Suprastin, help reduce the sensitivity of cells to histamine and relieve swelling of the intestinal mucosa.
- Treatment of a sigmoid diverticulum or any other part of the intestine in most cases includes the use of antispasmodic drugs, for example, No-Shpy or Meteospasmil. These funds help relieve spasm from the intestinal wall, relieve pain, and alleviate the patient’s condition.
- Laxatives for diverticulitis are used with extreme caution. These drugs, of course, thin the feces and facilitate bowel movements. On the other hand, while taking laxatives, the pressure in the intestinal lumen increases, which can provoke a diverticulum rupture.
The right diet for diverticulitis
Treatment of a sigmoid colon diverticulum (or any other part of the digestive tract) must necessarily include an appropriate diet. If we are talking about inflammation, intestinal spasm and inability to eat naturally, then the patient is given a dropper with glucose and a solution of electrolytes.
In the future, it is extremely important to monitor the diet. From the menu you need to exclude products that promote gas formation in the intestines (legumes, whole milk, grapes). Coarse dietary fiber contained in pineapples, persimmons, radishes and turnips is also contraindicated. Patients are advised to refuse white bread, blueberries, rice, pomegranate, as these products contribute to the development of constipation.
The diet, however, should be rich in fiber. Doctors recommend that patients eat granola, some cereals, oatmeal, peaches, berries, seaweed, avocados, pears. When dealing with constipation, it is important to observe the water balance - drink at least 2 liters of plain, clean water daily.
Diverticulums: operation and indications for its implementation
With the help of correctly selected drugs, you can get rid of inflammation. However, diverticulum removal is sometimes necessary. The operation can be planned (it is carried out 2-4 months after the successful medical treatment of inflammation in order to prevent relapse) and emergency (in the presence of intestinal bleeding, risk of rupture of the diverticulum).
If we talk about emergency surgical intervention, then the indications for it are:
- rupture of the diverticulum and the exit of its contents into the abdominal cavity with the further development of peritonitis,
- acute intestinal obstruction,
- the appearance of infiltrate in the protrusion cavity,
- suppuration of tissues
- bleeding that cannot be controlled with medication,
- the risk of malignant degeneration of diverticulum cells,
- fistula formation.
Excision of the protrusion of the intestinal wall is not carried out for elderly patients, as well as pregnant women. Contraindications include severe pathologies of the cardiovascular system (there is a risk of a reaction to anesthesia), chronic diseases during an exacerbation, as well as any acute inflammatory or infectious diseases.
Of course, traditional medicine offers a lot of tools to combat one or another inflammatory bowel disease.
Treatment of diverticulitis of the sigmoid colon (or any other part of the digestive tract) may include taking a tincture of medicinal smoky. Cooking it is quite simple - you just need to pour two tablespoons of dry raw materials into a thermos and pour all 500 ml of boiling water. The mixture is recommended to leave overnight. Patients take half a glass before meals three times a day.
Oatmeal jelly also has beneficial properties. Some folk healers also recommend that you include flax and plantain seeds in your daily diet, and use olive or flaxseed oil as a dressing for salads. For intestinal diseases, peppermint tea and alcohol from tern are effective.
Of course, home remedies can only be used as adjuvants. In no case should you give up drug therapy, especially when it comes to acute inflammation.
Unfortunately, today many patients are faced with such a problem as intestinal diverticulum. Treatment of pathology in most cases is successful. Nevertheless, even after completion of therapy, patients are advised to adhere to certain rules that help prevent the formation of new diverticula:
- Important are regular sports. Physical activity has a positive effect on blood circulation, which in turn normalizes the tone of the smooth muscles of the intestinal wall.
- To support normal peristalsis of the digestive tract, about 25-30 g of fiber is recommended every day. This substance helps to facilitate the passage of food through the intestines, prevent the development of chronic constipation.
- It is necessary to maintain water balance - every day you need to use at least 1.5-2 liters of clean, still water.
- Vegetable oils have a positive effect on health. At least three times a week you need to eat at breakfast a tablespoon of flaxseed or olive oil.
- Of course, it is important to maintain immunity. If you have any health problems, you need to see a doctor on time.
Diverticulosis of the bladder: symptoms and treatment
According to statistics, in 80% of cases of diverticulum formation occurs precisely in the intestine. However, quite often, in modern medicine, the appearance of such protrusion in the bladder wall is also recorded.
In most cases, the disease develops against the background of such pathologies as urethral stricture, prostate adenoma, and sclerosis of the bladder neck. Due to increased pressure, the wall of the bladder is stretched - this forms the diverticulum. It is worth noting that inside the protrusion, urine often accumulates, which ultimately leads to inflammation.
In no case should you ignore such a problem as diverticula. Surgery is sometimes simply necessary, regardless of whether we are talking about pathologies of the bladder, intestines or other organ.
Nevertheless, the prognosis for patients is favorable - in most cases, correctly selected drug therapy and a surgical procedure help get rid of the problem.
Intestinal diverticulums can be congenital (with a hereditary pathology of the connective tissue) or acquired (associated with age-related weakness of the interstitial fibers). Diverticulums are rare in the small intestine - in 1% of patients, while in most cases Meckel’s diverticulum containing the tissues of the stomach or pancreas is detected. Intestinal diverticula are often multiple and are located in the left half of the colon (in 70% of cases). At a young age, diverticulosis is detected only in 5% of cases, between the ages of 40 and 60 years - in 30% of the population, and after 80 years, the incidence of bowel diverticulum is more than 65%. Intestinal diverticulum can be complicated by inflammation, bleeding, perforation, but almost never accompanied by malignancy. In recent years, there has been an increase in cases of diverticulosis in developed countries, which is associated with a change in dietary habits, the exclusion of fiber and healthy dietary fiber from the diet.
Causes of intestinal diverticula
Various factors can lead to the appearance of congenital and acquired intestinal diverticulums, but weak connective tissue is the basis of all of them. With congenital connective tissue dysplasia, diverticula are usually multiple, located not only in the intestine, but also in other organs (stomach, bladder, etc.). In the first years of the disease, the wall of congenital diverticula is represented by all layers of the intestinal wall, however, muscle fibers atrophy with age. The occurrence of acquired intestinal diverticulums is facilitated by nutrition errors (the use of semi-finished foods, irregular meals, the exclusion of fiber, fresh fruits and vegetables from the diet), vitamin deficiency, persistent constipation, intestinal motility disorders, a sedentary lifestyle, and obesity.
Any of the above causes leads to an increase in intestinal pressure, prolapse of the mucous and submucosal layers of the intestine between muscle fibers, the formation of a cavity formation with a diameter of 3-5 cm. In the small intestine, Meckel's diverticulum is most often encountered - congenital incomplete overgrowth of the vitelline duct, and therefore approximately 50 cm from the bauginium damper, a finger-shaped protrusion forms on the intestinal wall, which connects to the intestine with a wide anastomosis. Sometimes a single intestinal diverticulum is formed in the duodenum - near the Vater's nipple or in the duodenal bulb (most often this happens against the background of duodenal ulcer). Other localizations of small intestine diverticulosis are quite rare.
In the large intestine, diverticula are mainly formed in the sigmoid and left half of the transverse colon. Most often, intestinal diverticula are arranged in two rows, one on each side along the mesentery. Colonic diverticulums tend to progress with age - increased pressure in the intestine, stagnation of fecal contents have a pulsating (squeezing) effect, which causes more and more protrusion of the intestinal wall.
Classification of intestinal diverticula
Distinguish between congenital and acquired forms of intestinal diverticula. Congenital diverticulosis is often multiple, protrusions are localized in various organs. Also, intestinal diverticula can act as a component of Sent's congenital triad, combined with a hiatal hernia and cholelithiasis.
Acquired intestinal diverticula with age are formed in almost 80% of the population. They can be traction (with adhesive disease), false (in the absence of muscle fibers in the protrusion wall), formed against the background of diseases and injuries of the intestine. By localization, diverticula of the small and large intestines are distinguished. As a result, asymptomatic, clinically apparent and complicated intestinal diverticula are distinguished.
The complications of the disease include acute and chronic diverticulitis, adhesions and intestinal obstruction, perforation and rupture of the diverticulum, abscess formation and fistula formation, intestinal bleeding, increased bacterial colonization of the intestine.
Symptoms of intestinal diverticula
Intestinal diverticulums in most cases do not appear for a long time, being discovered by chance during an examination for other diseases. Clinically obvious forms of intestinal diverticula most often indicate the possibility of complications. The onset of symptoms and complications of diverticulosis is associated with impaired motility of the intestinal wall, stagnation of the intestinal contents, both in the intestine and in the protrusion cavity, and an increase in intestinal pressure. All these factors lead to the appearance of increased bacterial seeding (more than 1 million cells per ml), the formation of fecal stones, and thinning of the intestinal wall in the places of passage of blood vessels.
Clinically, diverticulums of the small intestine are manifested by vague abdominal pain, chronic diarrhea. The protrusion of the walls of the large intestine can also cause abdominal pain, more in its left half, often associated with bowel movements and disappearing after it. Also, stool instability is characteristic of this disease - constipation is constantly alternating with diarrhea and periods of normal stool. On examination, feces are formed in the form of balls surrounded by mucus. Patients are concerned about increased flatulence, an abundant discharge of intestinal gases.
With prolonged stagnation of fecal contents in the diverticulum of the intestine, irreversible changes in the intestinal wall occur, the intestinal flora activates and diverticulitis occurs - one of the most common complications of this disease. A chronic inflammatory process can exist for a long time, causing frequent recurrent bleeding, local peritonitis with the formation of adhesions, fistulas that connect the intestinal cavity with the vagina, bladder, and skin.
Severe inflammation in the cavity of the diverticulum can lead to perforation of its wall, the release of intestinal contents into the abdominal cavity with the formation of an intestinal abscess, and in severe cases, diffuse peritonitis. Perforation of the intestinal diverticulum is characterized by a clinic of "acute abdomen", which is often confused with acute appendicitis. Diagnostic error is usually detected only during an operation in which intestinal diverticula are found.
Diagnosis of intestinal diverticula
It is rather difficult to suspect the presence of intestinal diverticulum in a patient, since this disease does not have a specific clinical picture. Most often, intestinal diverticulums are detected by chance, when searching for the cause of anemia, excluding intestinal tumors. If a diverticular disease is suspected, the gastroenterologist will prescribe a number of laboratory tests: a general blood test will determine inflammatory changes and anemia, a fecal occult blood test will help to detect intestinal bleeding in time, and a coprogram and bacteriological examination of the feces will diagnose intestinal dysfunction, digestion and increased bacterial contamination.
Patients with this disease require irrigography, preferably with double contrast. On the x-ray, protrusion of the intestinal wall will be visible, communicating with the intestinal cavity. It should be remembered that in the presence of complications of intestinal diverticulums, first you need to do an overview radiography of the abdominal organs, make sure there are no signs of perforation, and only then prescribe an irrigography.
Consultation with an endoscopist is mandatory both in the presence of an asymptomatic form of intestinal diverticulums and in cases of suspected complications. The use of endoscopic diagnostic methods (colonoscopy, sigmoidoscopy) is indicated only after stopping signs of inflammation. Colonoscopy is an indispensable method of finding the source of bleeding with intestinal diverticula, but it can contribute to the appearance of complications of the disease. The advantage of endoscopic techniques is the possibility of biopsy, morphological studies of biopsy specimens.
For differential diagnosis with other diseases, ultrasound, CT, MSCT of the abdominal organs may be required. Differentiation of intestinal diverticula should be with ectopic pregnancy, hypochromic anemia, pseudomembranous colitis, irritable bowel syndrome, Crohn's disease, acute appendicitis, celiac disease, bowel cancer, ischemic colitis.
Bowel diverticulum treatment
Treatment of patients with an uncomplicated form of intestinal diverticulums is carried out in the department of gastroenterology, and in case of severe complications - in a surgical hospital. Hospitalized patients with acute or exacerbation of chronic diverticulitis, intoxication, high fever, severe concomitant pathology, inability to enteric nutrition, as well as over the age of 85 years. In the presence of a clinic of an acute abdomen, an urgent operation is performed.
If the patient accidentally has an asymptomatic diverticulum of the intestine, prescribing special treatment is not required. The patient is recommended to introduce a sufficient amount of fiber into the diet, observing the principles of a healthy diet. In the presence of a clinic of uncomplicated intestinal diverticulums, a diet rich in fiber, antispasmodics, prokinetics is prescribed. With all the recommendations for the treatment of the disease, a consistent clinical effect is usually achieved. If the patient develops diverticulitis, the use of intestinal antiseptics, antibiotics, osmotic laxatives is recommended.
To normalize the work of the intestine, one should abandon cleansing enemas, uncontrolled use of laxatives. A positive effect is achieved when moderate physical exertion is introduced into the day regimen - they help strengthen the muscular torso of the body, normalize intestinal motility. To reduce pressure in the intestinal lumen, a diet rich in fiber is prescribed (except for very coarse fibers - pineapples, persimmons, turnips, radishes). The amount of fiber in the diet is increased to 32 g / l. It is necessary to exclude gas-forming products, legumes, carbonated drinks. To achieve the desired effect, at least two liters of water should be consumed daily.
The use of stimulant laxatives, morphine-based pain relievers for intestinal diverticula is contraindicated, as they provoke further impaired intestinal motility, aggravate the course of the disease. To improve the passage of food masses through the intestines, osmotic laxatives are prescribed - they increase the amount of feces and accelerate their progress through the digestive tract. With diarrhea, sorbents and astringents are prescribed, for stopping flatulence - simethicone preparations.
Acute diverticulitis requires hospitalization of the patient in a surgical hospital, the appointment of detoxification and plasma-replacing agents, antibacterial drugs. Treatment lasts at least two to three weeks, after discharge from the hospital, maintenance therapy is similar to that carried out with uncomplicated intestinal diverticula.
Surgical treatment is indicated for life-threatening complications: perforation, abscessing, intestinal obstruction, profuse bleeding, fistula formation. Also, a planned operation is prescribed for recurrent bleeding and diverticulitis. Typically, with intestinal diverticula, a part of the intestine affected by diverticulosis is resected with an anastomosis. In difficult situations, a colostomy is applied to facilitate the outflow of feces, and after stabilization, a reconstructive operation is performed.
Prognosis and prevention of intestinal diverticula
The prognosis in the presence of intestinal diverticulums is usually favorable, but sometimes this disease leads to the development of life-threatening complications. Diverticulitis occurs in about a quarter of patients. The effectiveness of his treatment in the first episode is the highest - up to 70%, with the third episode the effectiveness of therapy is reduced to 6%.
Prevention of congenital diverticulum of the intestine does not exist. The development of acquired diverticulums can be prevented by normalizing the diet and diet, consuming enough fiber and fluid, and using moderate physical exertion.
The concept of diverticular disease
Diverticulums are sack-like protrusions on the walls of an organ. The size of diverticula is 5-10 millimeters. Formations up to 5 mm usually do not cause patient complaints and are asymptomatic. The peripapillary and parafateral diverticulum of the intestine is almost always false, since it consists only of the mucous layer with small vessels protruding between the muscle fibers.
Diverticular disease is divided into three main varieties: diverticulosis, diverticulitis, diverticular bleeding.
A diverticulum of the duodenum is a hernia-like formation on the walls of the upper intestine. It often occurs in people over 60 years of age, mainly in obese people, the same in men and women. The intestine is prone to the formation of diverticula, since it is a hollow organ.
Diverticular pockets are located along the entire length of the duodenum, but most often on the inside in the middle. They can also be located along the entire length and acquire huge dimensions. The danger of diverticulums is that they squeeze the bile duct, causing icteric symptoms. Chronic pancreatitis often results from diverticular disease.
The diverticulum of the duodenum can be parapapillary, parafaterial in its location.
Causes of duodenal diverticulum development
There is no unified medical opinion on the causes of diverticulum formation in this part of the intestine. It is a well-known fact that for the occurrence of diverticulosis, one of three conditions must be met:
- Weakened tissue forming organs.
- Great intra-intestinal pressure.
- Pressure outside.
Factors causing diverticular diseases can be either congenital or acquired. In people with congenital pathologies in the form of weak walls of the duodenum, the disease develops at a young age. But there are few such cases in medical practice. From this we can conclude that most cases of diverticula in the duodenum are caused by acquired factors. An extensive group of provocateurs belongs to the group of natural age-related changes.
Age-related changes leading to the formation of diverticula:
- Loss of tissue elasticity, stretched intestinal wall.
- Atrophy of the abdominal muscles.
- Muscle discrepancy.
- Hernia in the groin and navel and others.
Diverticulosis is congenital. As a rule, this is accompanied by other pathologies of the gastrointestinal tract.
Duodenal diverticulitis is poor in symptoms. In most cases, patients do not know about their disease. Identify by chance in the diagnosis of concomitant diseases. In some cases, the symptoms are moderate or intense.
Symptoms are often simulated, complaints are similar to signs of the following diseases:
- Diseases of the liver and gall bladder.
- Pancreatic disease with weight loss.
The severity of complaints diverticulum is divided into:
Common complaints of patients with diverticulosis:
- Abdominal pain in the lower right rib is a characteristic symptom.
- Increased pain after eating and overeating.
- Belching with an unpleasant odor.
- Bowel obstruction and diarrhea with complications.
Dverticulitis can become acute. In this case, they talk about complications. These are inflamed diseases of a saccular mass. A prerequisite for the development of diverticulitis is the presence of perforations of various sizes in the walls of the neoplasm. When filling the diverticulum with food and mucus, the pressure inside increases and perforation occurs. Diverticulitis can be simple or complicated. Simple account for 75% of all cases.
If the pain radiates to other parts of the abdomen, an infection of not only the duodenum 12, but also other organs is suspected. Inflammation is characterized primarily by elevated body temperature.
During the diagnosis, the following diagnoses are excluded:
- Inflammation of the pelvic organs.
Detect using x-ray examination, computed tomography, ultrasound, irrigoscopy and endoscopy. Diverticulitis is often accompanied by an abscess.
Obstruction is the complete obstruction of a hollow organ. Duodenal obstruction is rare. More often partial obstruction due to edema and spasm of the intestinal muscles.
With the inability of intestinal tissues to limit inflammation (decreased immunity), an abscess begins. This is inflammation of the tissues surrounding the intestine with the formation of pus. In this case, the infected tissues dissolve, exfoliate and change their structure. Even the stomach is involved in the process.
Symptoms of an onset abscess: fever, not responding to antibiotics and antipyretics and formations, painful on palpation.
Almost all intestinal abscesses are stopped by antibiotics. Also used drainage through a puncture in the skin, as one of the most effective tools.
Fistula appears in 2% of cases, but affects the quality of life of patients. It can be single or multiple. Colovaginal or colovasic fistulas are found.
With the opening bleeding, cancer is suspected, since 90% of all rectal bleeding is associated with cancer. It starts suddenly, very profusely, requires urgent hospitalization and blood transfusion.
In 40% of cases, diverticular bleeding recurs.
When diagnosing and treating, it is required to establish the source of bleeding, often this cannot be done.
Conservative therapy is an outpatient treatment. Correction of nutrition in order to exclude products that produce a large amount of feces. In the presence of obesity, weight is adjusted. After eating, it is recommended to take a special posture, depending on the localization of diverticula for the prevention of food stagnation.
Antibiotic therapy. Apply antibiotics for 7-10 days. Improvement occurs in 2-3 days. If therapy is ineffective, a study is conducted for complications.
Antispasmodics are prescribed to relieve pain and tension.
Hospitalization is rarely required, in severe cases. A strict diet is mandatory with a sparing menu, meals in small portions, with dinner no later than 4 hours before bedtime. Enema, gastric cleansing, intravenous antibiotic preparations and fluids are recommended; analgesics are used to relieve symptoms. 30% of hospitalizations require surgery.
The operation takes place under general anesthesia. At this time, it is difficult to detect a saccular growth. To facilitate the search apply air blowing. The diverticulum is removed by resection. With extensive damage and multiple inoperable diverticula, the duodenum is excluded. The postoperative prognosis is favorable, patients are rehabilitated and return to their usual lifestyle.