Diverticulosis is the presence of multiple diverticula.
Content
What are intestinal diverticula?
A diverticulum is a congenital or acquired protrusion of the wall of a hollow organ. They can occur in all organs of the gastrointestinal tract.
Small intestinal diverticula are most often found in the duodenum. In the jejunum and ileum they occur in 1% of patients.
In the large intestine, diverticula are found in
- 5% of young people,
- 30% of people aged 40 to 60 years,
- 50% of people who have reached 80 years of age.
The incidence of diverticulosis has increased in the last decade in economically developed countries whose residents do not eat coarse fiber.
What types of diverticula are there?
There are congenital (true) and acquired diverticula.
Types of diverticula
| View | Description | Cause |
|---|---|---|
| Congenital | Meckel's diverticulum | Ileal diverticulum occurs as a result of a violation of the reverse development of the intestinal part of the bile duct. |
| Duodenal diverticulum | Occurs in places of congenital underdevelopment of the muscle membrane | |
| Diverticulum of another location | ||
| Purchased | Pulse diverticulum | Occurs due to the effect of high intraintestinal pressure on the altered intestinal wall |
| Traction diverticulum | Develops during the adhesive process, as a result of traction on the intestinal wall from the outside | |
| False diverticulum | Formed due to protrusion of only the mucous and submucosal base through a defect in the muscular layer of the intestinal wall |
A true (congenital) formation consists of three membranes of the intestinal wall and is much less common than an acquired one.
Duodenal diverticula are classified as so-called pulsion diverticula. The pulsation is caused by contractions of the smooth muscle layer of the intestine.
Reasons for appearance
Congenital diverticula of the duodenum arise in places of congenital underdevelopment of the muscular membrane.
Acquired duodenal diverticula are the result of duodenal ulcer and recurrent pancreatitis.
The vascular factor plays a great role in the occurrence of diverticula: with spasm of the muscle layer, intrawall vessels are compressed with impaired microcirculation - ischemia and slowing of venous outflow, dystrophic changes develop, which subsequently become the site of formation of diverticula.
Reasons for the development of acquired diverticula:
- reduction in the content of plant fibers and fiber in the diet;
- weakening of the tissues of the intestinal wall during the aging process;
- weakening and disruption of intestinal motor function (constipation);
- adhesions in the intestines;
- significant increase in intraintestinal pressure.
Intestinal pressure can increase bile acids, stimulating intestinal function. Dietary fiber contained in bran and plant fiber has the property of lowering blood pressure.
Symptoms
This disease often may not be accompanied by symptoms for a very long time.
Approximately 70% of duodenal diverticula are located in the area of the major duodenal papilla (usually at a distance of 1-2 cm). They are the ones who most often exhibit characteristic symptoms.
With duodenal diverticulosis, patients may feel pain in the right hypochondrium, radiating to the back and right shoulder blade. Sometimes the pain takes on a girdling character.
Vivid symptoms appear with the development of complications.
Complications
The disease can take the following forms:
- acute diverticulitis;
- chronic diverticulitis;
- intestinal obstruction (due to adhesions around the diverticulum);
- diverticulum rupture (perforation);
- intestinal bleeding;
- bacterial infection of the small intestine;
- colon dysbiosis.
With Meckel's diverticulum, intussusception often occurs.
Acute intestinal diverticulitis
Diverticulitis is an inflammation, purulent complication (abscess) of a diverticulum - accompanied by the following symptoms:
- peritoneal irritation;
- symptoms of intestinal obstruction;
- changes in blood tests;
- high body temperature.
This complication occurs as a result of stagnation of intestinal contents in the diverticulum, which occurs when the inlet is narrow.
As a result, perforation of the diverticulum may occur, an intra-abdominal abscess, and external and internal intestinal fistula may form.
Chronic diverticulitis
The acute form of the disease can develop into chronic recurrent diverticulitis. In this case, the following symptoms occur:
- periodic severe pain in the projection of the inflamed area of the intestine;
- in most cases the sigmoid colon is affected.
Diverticula of the upper horizontal part of the duodenum manifest themselves as symptoms of peptic ulcer . This is due to the penetration of acidic contents into them and the occurrence of erosion and ulcers.
A diverticulum of the descending intestine, when an inflammatory process occurs, can lead to compression of the major duodenal papilla (papilla of Vater) with the subsequent development of cholangitis, pancreatitis, and obstructive jaundice.
Jejunal diverticula can ulcerate and perforate into the abdominal cavity.
With jejunal diverticulosis, bacterial damage to the small intestine often occurs, which is manifested by such symptoms as:
- chronic diarrhea;
- weight loss;
- dysbiosis of the small intestine.
Colon diverticulosis
The pain is localized more often in the left iliac region and in the projection of the sigmoid colon and is of the nature of spasms, intensifying as the colon with feces. After defecation, the pain usually decreases. Some patients note a dull aching pain in the same areas during the period between these spasms.
When palpating the abdomen, it is impossible to determine the location of the painful focus. The duration of pain varies from several days and weeks to constant pain for a long time.
Diverticular disease of the colon is characterized by
- constipation,
- bloating,
- pain in the projection of the colon,
- rarely bleeding.
The most serious complication of diverticulosis of the large intestine is perforation of the diverticulum into the free abdominal cavity with the subsequent development of fecal peritonitis. It occurs especially often in elderly people and is dangerous because the symptoms of peritoneal irritation in them are less clearly expressed than in young people.
Diagnostics
Most often, diverticulosis is detected by X-ray examination .
Irrigoscopy (x-ray examination with a barium enema) reveals not only the presence of diverticula, but also the possibility of their inflammation .
For this purpose, parameters such as
- tone and elasticity of the intestinal wall,
- width of the intestinal lumen,
- character of haustration,
- height of intergaustral folds.
If elderly people present with vague abdominal pain, a survey of the abdominal cavity is taken to identify the cause.
An informative method for identifying colon diverticulosis is colonoscopy , which, in addition to identifying diverticula, allows one to clarify the extent of inflammatory changes in the intestinal lumen, the location of diverticula and the condition of their mucous membrane.
However, for diverticulitis, colonoscopy can lead to perforation of the colon and should only be used if it is truly necessary. Only the attending physician has information about the need to use all diagnostic methods.
If diverticulosis is complicated by bleeding, then its source is also determined using colonoscopy, although its implementation under these conditions is complicated.
Treatment
For uncomplicated forms of diverticulosis, treatment consists of dietary nutrition. The patient is recommended to constantly take coarse wheat bran, which has the ability to lower intestinal pressure.
You should start taking 2-3 teaspoons per day and gradually increase to 3-9 tablespoons. The optimal dose is considered to ensure regular bowel movements at least once every 2 days.
If bran does not help, then prokinetics (Motilium, Prepulsid, Cerucal) and enzyme preparations (Creon, etc.) are prescribed.
For episodes of diarrhea and flatulence, antibacterial drugs are indicated (for example, Intetrix, Ersefuril, etc.).
Treatment of diverticulitis
In case of inflammation and in the absence of symptoms of acute inflammation (irritation of the peritoneum, high temperature, poor blood count), conservative treatment with antibacterial drugs is possible until the inflammatory processes in the diverticulum area subside.
With acute symptoms, treatment tactics change. In this case, hospitalization of the patient is required. In case of severe intoxication, complex therapy is prescribed - laxatives (vaseline oil) to soften stool, a slag-free diet with limited fiber, broad-spectrum antibiotics, antispasmodics, physiotherapy. To exclude perforation of the colon, an X-ray examination of the abdominal cavity is performed.
If symptoms of acute purulent diverticulitis appear, an urgent operation is necessary - resection of the diverticulum.
Resection of a diverticulum of the descending part of the duodenum is considered a complex operation and is resorted to only in the presence of absolute indicators (perforation, obstructive jaundice, severe bleeding).
Small, single, uncomplicated diverticula of the small and large intestines do not require surgical treatment.
Indications for surgery are:
- large diverticulum;
- tendency to inflammation.
Bleeding with diverticulitis is usually not massive. They are treated with conservative methods. It is possible to stop bleeding during a colonoscopy procedure.
In case of prolonged, frequently recurring bleeding and the development of anemia, resection of the affected part of the intestine is recommended.
Forecast
The prognosis for diverticulosis of the small intestine is unfavorable, as it leads to serious malabsorption. The possibilities of surgical treatment are limited, since with multiple diverticula, extensive resection leads to complications.
With diverticulosis of the colon, the prognosis is favorable.
Although a lack of coarse plant fiber in the diet can lead not only to diverticulitis, but also to colon cancer, both diseases rarely occur at the same time.
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