Page 1 of 3
The diverticulum — the inborn or acquired protrusion of a wall of hollow body, meets in all departments of a digestive tract.
In a small bowel diverticulums reveal seldom (in 1% of cases), usually they are localized in a jejunum and at the same time in other departments of intestines. In an ileal gut sometimes it is possible to find Mekkel's diverticulum which is the rest of a vitelline stalk. In 20 — 50% of cases it contains tissue of a mucous membrane of a stomach and in 7% — pancreas tissue. In a large intestine diverticulums occur at 5% of persons of young age, at 30% of persons aged from 40 till 60 flyings and at 50% of the people who reached 80 years. In 70% of cases diverticulums are localized in sigmoid department of a large intestine in the form of the multiple educations which are seldom reaching 2 — 3 cm in the diameter. Divertuculosis frequency (existence of multiple diverticulums) in the last decades considerably increased in economically developed countries which residents do not eat rough cellulose.
Etiology and pathogeny
Substantial increase of the intra intestinal pressure operating on the changed gut wall is the reason of a divertuculosis. As a result mucous and submucosal covers prolabirut through defects of a muscular layer, forming multiple protrusions, so-called false diverticulums. True diverticulums — the inborn educations consisting of three layers of an intestinal wall meet much less often.
The bile acids stimulating motility of intestines are capable to increase intra intestinal pressure. The food fibers which are contained in bran, a cellulose possess property to lower pressure.
I. Inborn diverticulums:
a) Mekkel's diverticulum,
b) other localization.
II. The acquired diverticulums:
a) resulting from diseases of intestines or at its damages,
b) traction diverticulums,
c) false diverticulums.
a) acute diverticulitis,
b) chronic diverticulitis,
c) intestinal impassability (commissural process around a diverticulum),
d) rupture of a diverticulum,
e) intestinal bleeding,
e) bacterial contamination of a small bowel.
Approximate formulation of the diagnosis:
1. Divertuculosis of a small bowel (inborn); a syndrome of bacterial contamination with chronic diarrhea, food decline.
2. Divertuculosis of a large intestine; the chronic diverticulitis, perisigmondit, a phase of the fading aggravation.
3. Nonspecific ulcer colitis in a remission phase; multiple pseudo-diverticulums of the descending department of a large intestine.
Clinical picture, diagnosis
Diverticulums find during X-ray inspection. They quite often can not be followed by clinical symptoms. At most of patients with a divertuculosis of a jejunum the so-called syndrome of bacterial contamination which is characterized by chronic diarrhea, abdominal distention and other disturbances of absorption develops. At a divertuculosis of a large intestine locks and pain in a projection of a large intestine are more often observed.
The characteristic symptomatology at a divertuculosis appears in case of complications — inflammations, ulcerations, perforation, bleedings. Purulent complications (a diverticulum inflammation, abscess) are followed by pain, high temperature of a body, symptoms of irritation of a peritoneum, impassability. Inflammatory process can lead to perforation of a diverticulum and peritonitis, and also to formation of outside and internal fistulas.
The divertuculosis can be the reason of rectal bleeding. Diagnosis in these cases is difficult. The bleeding point is established by means of a kolonofibroskopiya which performance in these conditions is considerably complicated.
The divertuculosis of a large intestine is sometimes combined with hernia of an esophageal opening of a diaphragm and cholelithiasis (Sant's triad). It is important to consider a possibility of such combination in the course of diagnosis of these diseases and their treatment.
At uncomplicated forms of a divertuculosis treatment mainly dietary: continuous reception of wheat bran of a rough grinding is recommended to the patient (gradually raising a dose from 2 — 3 teaspoons to 3 — 9 tablespoons a day). The dose providing a regular chair at least 1 time in two days is considered optimum.
If necessary in addition apply cerucal, festal. In case of episodes of diarrhea, a meteorism Biseptolum, sulfaguanidine, Intestopanum or other antibacterial drugs are shown. At complications of purulent character and signs of an acute abdomen urgent operation — a resection of an affected area of a gut is shown.
In the absence of symptoms of irritation of a peritoneum, high fever and shifts of a leukocytic formula inherent to purulent processes, appoint parenteral antibacterial therapy before subsiding of the inflammatory phenomena in a diverticulum zone.
Bleedings at a divertuculosis usually do not happen massive and are treated by conservative methods. At long recurrent bleedings, the resection of the struck part of a gut is shown to anemia.
The forecast at a divertuculosis favorable. In spite of the fact that deficit of a cellulose can lead not only to a divertuculosis, but also to a colon cancer, these diseases are combined seldom.