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Endoscopy - intestines Diverticulums

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Intestines diverticulums
Development, structure, current

Considering that clinical manifestations of a divertuculosis and its complications are not specific, the exact diagnosis is established only after carrying out tool inspection of a large intestine. Kolonoskopiya as a high-informative method, the extent and degree of manifestation of pathological changes of an intestinal wall allows to estimate. However at this disease its use has certain restrictions and contraindications. At endoscopic survey in most cases the tone of the struck segment is raised, folds are thickened, spazmirovana, in mezhgaustralny spaces are visible single or multiple mouths of diverticulums with a diameter from 0,5 to 2 cm. A mucous membrane around mouths pink, smooth, brilliant. Sometimes in a gleam of diverticulums dense intestinal contents are defined. As a rule, at elderly patients with a divertuculosis the expressed hyper tone of an intestinal wall leads to disturbance of microcirculation which is followed by change of permeability of small vessels. In these cases it is macroscopic in a defeat zone a mucous membrane of light pink color, vascular drawing is grown a little poor, single or multiple subepithelial punctulate hemorrhages are determined by tops of folds. Contact bleeding is absent, inflammatory changes in area of mouths of diverticulums are not noted.


The endoscopic picture of a diverticulitis depends on degree of manifestation of inflammatory changes. At slightly expressed inflammation the mucous membrane in the field of the mouth of one, less often than several diverticulums is moderately edematous, hyperemic, the mouth is narrowed, but is accurately visualized. On a cover mucosal surface in this zone there are imposings of slime or fibrin.
At the expressed inflammation the mouth of the changed diverticulum (or several nearby diverticulums) in most cases is not differentiated, the center of a hyperemic, edematous infiltrirovanny mucous membrane with punctulate hemorrhages and imposings of fibrin is visible. As a rule, in this zone it is above and below mouths of not changed diverticulums are defined.
Considering a characteristic endoscopic picture, and also the high risk of development of perforation, morphological research at a diverticulitis is not made.
Extremely seldom at the expressed diverticulitis inflammatory process extends to all mezhgaustralny space with involvement of a nearby gaustra. The mucous membrane covering a fold is sharply edematous, hyperemic with the expressed infiltration that against a spasm causes narrowing of a gleam of a gut, considerable, insuperable to the endoscope. In this regard it is not possible to visualize vospalitelno the changed diverticulum (or diverticulums). However existence of diverticulums in underlying departments of a large intestine allows to establish the presumable diagnosis of a diverticulitis.
At morphological research the expressed cellular infiltration of a mucous membrane corresponding to an acute inflammation is noted. The biopsy is made for decrease in risk of perforation from sites of a mucous membrane of a reinforced gaustra (fold).
This form of a diverticulitis should be differentiated with a colon cancer. Nature of macroscopic changes and results of a biopsy in most cases allow to make the correct endoscopic diagnosis.

The divertuculosis complicated by colic bleeding

Diagnostic informational content of a kolonoskopiya at the divertuculosis complicated by bleeding depends on terms of carrying out survey (quality of training) and a clinical picture of a disease (the active proceeding or stopped bleeding). The emergency kolonoskopiya executed at bleeding height allows to establish authentically a bleeding point only in the presence of direct endoscopic signs (active receipt is fresher than blood from the mouth of a diverticulum) or at an exception of other diseases of a large intestine which can cause intestinal bleeding. According to various authors, in 10-20% of cases the diverticular illness is combined with cancer and in 22-25% — with polyps of a large intestine (Hunt R.H., 1981; Williams R.A. et al., 1995). At planned research the divertuculosis is, as a rule, diagnosed and the presumable level of bleeding which is determined by an arrangement of mouths of the diverticulums which are sealed up by clots is established.