diverticula are gryzhepodobnye bulging wall of the hollow body.The vast majority of diverticula of the sigmoid colon are not innate, and appear during the life of the patient as a result of malnutrition and the effects of other precipitating factors.In the case of ulcers in multiple diverticula, the disease is called "diverticulosis".If the wall diverticulum occurs inflammatory disease called "diverticulitis".Also, there is a concept in medicine "diverticular disease", which includes himself diverticulosis and its complications. Content
main place of localization of diverticula of the intestine is sigmoid colon.The
Men and women suffer from this disease equally.With regard to the prevalence in the region, we can say that the people of Africa and Asia, the diagnosis of "diverticulosis" is not as such, but in the West it is found very often.The reason is that Africans and Asians eat a lot of foods rich in fiber, and Westerners get enough fiber.
Despite the fact that there are also cases of congenital diverticulosis, defeat them sigmoid colon are often acquired character.
acquired diverticula can occur due to mechanical damage of the intestine against its inflammatory diseases or due to pathological processes of the intestine is providing traction on his wall (for example, adhesive disease of the intestine).
Depending on the nature of the flow of diverticulosis are distinguished:
Complications of diverticulitis usually are:
a result of morphological and functional changes in the intestine, as described above, and formed diverticula - mucosa and submucosa of the sigmoid colon, unable to bear the pressure exerted on themfeces, protrude outwardly through the weakened muscular layer of the intestinal wall (this layer is weakened in the maximum field penetration into the wall of blood vessels).
Regarding the anatomy of a diverticulum, he looks gryzhepodobnogo bulge outward from the gut cavity.Having a neck width of 0.3-0.5 cm and a body to 2 cm in diameter.Gradually diverticula increases in size, its walls while stretched, becomes thinner, can perforate (tear).Stagnation in the diverticulum of feces contributes to the formation of ulcers and erosions and inflammatory changes that can be complicated by bleeding.
In 80% of cases, the disease does not manifest itself, but is a random finding in the survey about other diseases.
Sometimes a patient suffering from diverticulosis, but are unaware of its existence, can not intensive bother recurrent pain in the left iliac region, often after a meal.After a bowel movement, or release gas pains are reduced or completely.The patient connects the symptoms to the fact that "ate something wrong," and medical care are not drawn.
If the diverticula develop in the wall of the inflammatory process, clinical picture becomes brighter: in the left iliac region having expressed pain intensity after defecation or flatus is not reduced.Pain lasting, persistent - do not stop for a few days, are amplified when moving the patient.The patient can clearly indicate location of the pain.On palpation the patient said field intensity of pain increases.Of the total symptoms should be noted the high body temperature - 40 degrees Celsius, nausea and vomiting, flatulence, alternating diarrhea and constipation.
If in the midst of the inflammatory process, and perforates the wall of a diverticulum in the abdomen out the contents of an infected ulcer - developing peritonitis.If the content falls into the retroperitoneal fat, purulent process is activated there appears abscess.In the event that the contents of an infected bowel mesentery between the sheets of the large intestine, an abscess formed parakolichesky.These states are characterized by a sharp deterioration in the patient's condition.He complains of marked weakness, abdominal pain, a sharp increase in body temperature.
In the case where the erosion or ulcer located in an infected diverticulum lead to vascular lesions, gastrointestinal bleeding occurs.It starts suddenly.The patient notices in the stool admixture of blood, the amount of which varies depending on the diameter of the affected vessel from minor to heavy.If it acquires the character of chronic bleeding, the patient develops anemia, manifested by general weakness, dizziness, shortness of breath with minimal patient stress and at rest, palpitations.In the analysis of the blood at the same time there is a decrease in hemoglobin level and red blood cells.
When the diverticulum is formed in the cavity of the abscess, there are two variants of its outcome:
most commonly diagnosed vaginal fistula enterocutaneous, enteric cystic and gastrointestinal.In the first case, the typical complaints of the patient will be abundant malodorous discharge from the genital tract, often - with a mixture of feces.During gastrointestinal fistula patient worried about repeated vomiting smelly stool particles in the vomit.Enteric cystic fistula manifested by frequent cystitis.The urine pus, fecal particles and air bubbles.It is more common in men.
consequence diverticulitis, existing for a long time, it becomes adhesive bowel disease that may one day be complicated by intestinal obstruction.
Based on the complaints of the patient and the detailed history of the disease and life (with particular emphasis on age, lifestyle - active or inactive, the nature of power, the tendency to constipation), the specialist suspects the presence of diverticula in the intestine.
confirm or refute the diagnosis tool to help research methods, such as barium enema and colonoscopy.
enema - a method of study of the intestine using a contrast agent and X-ray machine.Held in an outpatient setting, it is practically safe for the patient (sometimes there are cases of allergic reactions to the contrast agent).The method consists in the fact that the patient is introduced into the intestine agents delaying X-rays.As we move through the bowels of the liquid make some pictures X-ray machines, to give a picture of the cavity of the intestine.In the case of existing diverticula contrast and fills the cavity - the picture will be visible meshochkoobraznye bulge outward from the colon.
Colonoscopy - This study allows you to visually assess the state of the intestinal wall inside.To do this, use a special device - a colonoscope, which is a long, thin flexible tube with a camera on the end, the image which is displayed on the monitor.As part of the probe, there are several channels through which you can, if necessary, to hold a special tool for the purpose of diagnostic and therapeutic procedures (taking a piece of tissue for research, removal of polyps, coagulation bleeding vessel, for example).Research is safe for the patient and may also be performed on an outpatient basis, but in a specially equipped room.
colonoscope inserted through the anus into the intestine, gradually as the tube inspection advancing deep into the body.The presence of diverticulosis / diverticulitis colonoscopy point available in the intestinal wall diverticula mouth and signs of inflammation of the wall near them.In the case of spasm of the muscle layer of the intestine, which is characteristic of this disease, the doctor conducting the diagnosis, pay attention to some difficulty in the passage of tubes in certain places.
In some cases, due to the difficulty of diagnosis methods mentioned above can be assigned to the patient, such methods of visual studies as CT or MRI.
Other diagnostic techniques such as ultrasound of the abdomen and laboratory studies in the diagnosis of diverticulosis and diverticulitis of the sigmoid colon is not informative.They are only used for differential diagnosis and assessment of the nature and severity of existing complications.
Treatment of diverticulitis of the sigmoid colon vary depending on many factors:
In the case turned out to be a random finding diverticula and do not manifest themselves, the patient should be given advice on his diet.It should increase in the diet of vegetables, fruits, grains, legumes, nuts, trying to eat 30-35 grams of fiber per day.Also, a diet in this disease involves excessive drinking - 1.5-2 liters per day, of course, in the absence of contraindications.For sale is a lot of food supplements containing fat - if desired, the patient can use them.
If diverticulosis complicated with an inflammatory process, but his other complications are not available, treatment is carried out in a clinic and includes:
If the therapy for 2-3 days diverticulitis symptoms do not regress or progress, as well as in the case of othercomplications of the disease, the patient should be admitted to the hospital, where they will determine further treatment strategy:
80% of diverticulosis patients proceeds favorably without complicating throughout the life of the patient.
In 20% of cases the disease manifests itself, but its outlook is also favorable, as the recurrence of inflammation occurs in only 1 patient out of 4.
In repeated cases of inflammation prognosis worsens because each recurrence increases the risk of more serious complications.In this case, the output for the patient is a surgical procedure - resection of the lesion of the sigmoid colon.
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