Intestines diverticulums – meshotchaty protrusions of a wall thick, are more rare than a small intestine of the congenital or acquired character. Most often the asymptomatic form of a disease meets. Obvious clinical forms of diverticulums of intestines are shown by uncertain belly-aches, the dispepsichesky phenomena, bleedings. For diagnostics use an irrigografiya, a kolonoskopiya, a rektoromanoskopiya, ultrasonography and KT of abdominal organs. Specific therapy includes application of a diet with the increased content of cellulose, purpose of spazmolitik, prokinetik, antibacterial medicines, laktuloza. At the complicated course of a disease surgical treatment is required.
Diverticulums of intestines can have congenital (at hereditary pathology of connecting fabric) or acquired (connected with age weakness of interweft fibers) the nature. In a small intestine diverticulums meet rather seldom – at 1% of patients, at the same time in most cases reveal Mekkel's diverticulum containing tissues of a stomach or a pancreas. Diverticulums of intestines more often happen multiple and are located in the left half of a thick gut (in 70% of cases). At young age reveal only in 5% of cases, aged from 40 up to 60 years – at 30% of the population, and after 80 years defeat frequency diverticulums of intestines makes more than 65%. Diverticulums of intestines can be complicated by an inflammation, bleeding, perforation, however practically are never followed by a malignization. In recent years increase of cases of a divertikulez in the developed countries is noted that it is connected with change of dietary habits, an exception of a diet of cellulose and useful food fibers.
Reasons of diverticulums of intestines
Can lead various factors to emergence of the congenital and acquired diverticulums of intestines, but weakness of connecting fabric is the cornerstone of all of them. At a congenital soyedinitelnotkanny dysplasia diverticulums usually multiple, are located not only in intestines, but also other bodies (a stomach, a bladder, etc.). In the first years of a disease the wall of congenital diverticulums is presented by all layers of an intestinal wall, however with age muscle fibers atrophy. Emergence of the acquired diverticulums of intestines is promoted by food errors (the use of semi-finished products, irregular meals, an exception of a diet of cellulose, fresh fruit and vegetables), avitaminosis, constant locks, violations of motility of intestines, an inactive way of life, obesity.
Any of the above-mentioned reasons leads to increase in intra intestinal pressure, a prolapse of mucous and submucous layers of a gut between muscle fibers, to formation of band education with a diameter of 3-5 cm. In a small intestine Mekkel's diverticulum – a congenital incomplete zarashcheniye of a zheltochny channel in this connection approximately in 50 cm from the bauginiyevy gate on a wall of a gut finger-shaped protrusion is formed, wide sousty connecting to intestines most often meets. Sometimes single diverticulums of intestines are formed in a duodenum – near a faterov of a nipple or in DPK bulb (most often it happens against the background of stomach ulcer of a duodenum). Other localizations of a divertikulez of a small intestine meet rather seldom.
In a large intestine diverticulums are mainly formed in a sigmovidny and left half cross guts. Most often diverticulums of intestines are located in two ranks, on one from each party along a bryzheyka. Diverticulums of a thick gut tend to progressing with age – increase in pressure in intestines, stagnation of kalovy contents render the pulsionny (squeezing-out) effect because of what there are all new and new protrusions of an intestinal wall.
Classification of diverticulums of intestines
Distinguish the congenital and acquired forms of diverticulums of intestines. Congenital often happens multiple, protrusions are localized in various bodies. Also diverticulums of intestines can act as a component of a congenital triad of Sant, being combined with hernia of an esophageal opening of a diaphragm and cholelithiasis.
The acquired intestines diverticulums are formed practically at 80% of the population with age. They can be traction (at an adhesive disease), false (in the absence of muscle fibers in a protrusion wall), formed against the background of diseases and injuries of intestines. On localization distinguish diverticulums of a small and large intestine. On a current allocate the asymptomatic, clinically obvious and complicated intestines diverticulums.
Carry sharp to complications of a disease and chronic divertikulit, adhesive process and intestinal impassability, perforation and a rupture of a diverticulum, an abstsedirovaniye and formation of fistulas, intestinal bleeding, the raised bacterial obsemeneniye of intestines.
Symptoms of diverticulums of intestines
Intestines diverticulums in most cases are not shown a long time in any way, being found incidentally at inspection concerning other diseases. Clinically obvious forms of diverticulums of intestines most often indicate a possibility of development of complications. Emergence of symptomatology and complications at a divertikuleza is connected with violation of motility of an intestinal wall, stagnation of intestinal contents, both in a gut, and in a protrusion cavity, increase in intra intestinal pressure. All these factors lead to emergence of the raised bacterial obsemeneniye (more than 1 million cages in ml), to formation of kalovy stones, thinning of a wall of intestines in places of passing of vessels.
Clinically diverticulums of a small intestine are shown by uncertain belly-aches, chronic diarrhea. Protrusions of a wall of a large intestine are also capable to cause belly-aches, it is more in its left half, often connected with defecation and disappearing after it. Also instability of a chair is characteristic of this disease – locks constantly alternate with diarrhea and the periods of a normal chair. At survey kalovy masses is created in the form of the balls surrounded with slime. Patients are disturbed by the raised meteorizm, a plentiful otkhozhdeniye of intestinal gases.
At long stagnation of kalovy contents in diverticulums of intestines there occur irreversible changes of an intestinal wall, intestinal flora becomes more active and arises divertikulit – one of the most frequent complications of this disease. Chronic inflammatory process can exist a long time, causing frequent recurrent bleedings, local peritonitis with formation of solderings, the fistulas connecting an intestines cavity to a vagina, a bladder, skin.
The expressed inflammation in a cavity of a diverticulum can lead to perforation of its wall, an exit of intestinal contents in an abdominal cavity with formation of interintestinal abscess, and in hard cases – the poured peritonitis. Perforation of a diverticulum of intestines is characterized by clinic of "a sharp stomach" which is very often confused to an acute appendicitis. The diagnostic mistake usually comes to light only during operation on which find intestines diverticulums.
Diagnostics of diverticulums of intestines
It is rather difficult to suspect presence at the patient of diverticulums of intestines as this disease has no specific clinical picture. Most often diverticulums of intestines are found incidentally, by search of the reason of anemia, an exception of tumors of intestines. At suspicion of a divertikulyarny disease the gastroenterologist will appoint a number of laboratory researches: the general blood test the calla on the hidden blood will define inflammatory changes and anemia, the analysis will help to reveal intestinal bleeding in time, and the koprogramma and a bacteriological research a calla diagnose intestines dysfunction, violation of digestion and the raised bacterial obsemeneniye.
Patients with this disease demand carrying out an irrigografiya, it is desirable with double contrasting. In a x-ray picture the protrusions of an intestinal wall which are reported with an intestines cavity will be visible. It is necessary to remember that in the presence of complications of diverticulums of intestines at first it is necessary to make a survey X-ray analysis of abdominal organs, to be convinced of lack of signs of perforation, and only then to appoint an irrigografiya.
Consultation of the endoscopist is obligatory both in the presence of an asymptomatic form of diverticulums of intestines, and at suspicion on development of complications. Use of endoscopic methods of diagnostics (a kolonoskopiya, a rektoromanoskopiya) is shown only after knocking over of signs of an inflammation. Kolonoskopiya is an irreplaceable method of search of a source of bleeding at intestines diverticulums, however can promote emergence of complications of a disease. Advantage of endoscopic techniques is the possibility of carrying out a biopsy, a morphological research of bioptat.
For differential diagnostics with other diseases performing ultrasonography, KT, MCKT of abdominal organs can be required. It is necessary to differentiate intestines diverticulums with ektopichesky pregnancy, gipokhromny anemia, psevdomembranozny colitis, a syndrome of the angry intestines, a disease Krone, an acute appendicitis, a tseliakiya, intestines cancer, ischemic colitis.
Treatment of diverticulums of intestines
Treatment of patients with an uncomplicated form of diverticulums of intestines is carried out in office of gastroenterology, and at emergence of heavy complications – in a surgical hospital. Hospitalize patients with sharp or an aggravation of a chronic divertikulit, intoxication, high fever, the heavy accompanying pathology, impossibility of an enteroalimentation, and also 85 years are aged more senior. In the presence of clinic of a sharp stomach perform urgentny operation.
If at the patient the proceeding diverticulum of intestines is incidentally revealed asymptomatically, purpose of special treatment is not required. Recommend to the patient introduction to a diet of enough cellulose, respect for the principles of healthy food. In the presence of clinic of uncomplicated diverticulums of intestines the diet rich with cellulose, spazmolitik, pro-kinetics is appointed. At observance of all recommendations about therapy of a disease the lasting clinical effect is usually reached. If at the patient developed divertikulit, use of intestinal anti-septic tanks, antibiotics, osmotic laxative medicines is recommended.
For normalization of work of intestines it is necessary to refuse cleaning enemas, uncontrolled use of depletive. The positive effect is reached and at introduction to a day regimen of moderate physical activities – they help to strengthen a muscular corset of a trunk, normalize motility of intestines. For reduction of pressure in a gleam of intestines the diet rich with cellulose is appointed (except very rough fibers – pineapples, a persimmon, turnip, a radish). The amount of cellulose in a diet is increased to 32 g/l. It is necessary to exclude gas-forming products, bean, carbonated drinks. For achievement of necessary effect it is necessary to use not less than two liters of water every day.
Use of the stimulating depletive anesthetizing on the basis of morphine at intestines diverticulums contraindicated as they provoke further violation of motility of intestines aggravate a course of disease. For improvement of a passage of food masses on intestines appoint osmotic depletive – they increase the volume of kalovy masses and accelerate their advance on a digestive tract. At diarrhea sorbents and astringents, for knocking over of a meteorizm – medicines of a simetikon are appointed.
Sharp divertikulit demands hospitalization of the patient in a surgical hospital, purpose of dezintoksikatsionny and plazmozameshchayushchy means, antibacterial medicines. Treatment lasts not less than two-three weeks, after an extract from a hospital the supporting therapy is similar to that which is carried out at uncomplicated diverticulums of intestines.
Surgical treatment is shown at development of life-endangering complications: perforation, abstsedirovaniye, intestinal impassability, profuzny bleedings, formation of fistulas. Also planned operation is appointed at recurrent bleedings and divertikulita. Usually at diverticulums of intestines the resection of a part of the intestines affected divertikulezy with imposing of an anastomoz is made. In difficult situations the kolostoma for simplification of outflow of kalovy masses is imposed, and after stabilization of a state reconstructive operation is performed.
Forecast and prevention of diverticulums of intestines
The forecast in the presence of intestines diverticulums usually favorable, however sometimes leads this disease to development of life-endangering complications. Divertikulit arises approximately at a quarter of patients. Efficiency of its treatment at the first episode the highest – to 70%, at the third episode efficiency of therapy decreases to 6%.
Prevention of congenital diverticulums of intestines does not exist. It is possible to prevent development of the acquired diverticulums by normalization of the mode and a food allowance, the use of enough cellulose and liquid, use of moderate physical activities.