Polyps of a thick gut – the good-quality opukholevidny educations coming from a ferruterous epithelium of a mucous membrane of a large intestine. Are widespread, inclined to an asymptomatic current. Can cause frustration of a chair, belly-ache, emergence of slime and blood in Calais. In some cases polyps of a thick gut are capable or to provoke development of intestinal impassability. Are diagnosed taking into account complaints, data of objective survey, a rectal research, radiological and endoscopic techniques. Treatment – endoscopic or surgical removal of a polyp, a resection of an affected area of intestines.
Polyps of a thick gut
Polyps of a thick gut – good-quality outgrowths of a ferruterous epithelium mucous a large intestine in the form of knots on a wide or thin leg. According to some researchers, similar formations of a GIT come to light at 10-20% of inhabitants of the planet. Other scientists specify lower figures, believing that polyps of a thick gut occur at 2,5-7,5% of the population. Such difference in data is caused by impossibility to precisely establish prevalence of a disease because of tendency of polyps to an asymptomatic current.
Polyps of a thick gut arise at patients of all age, however more often (except for juvenile polyps) are found in people of mature age. The risk of development of tumors increases after 50 years. Polyps often become a casual find when carrying out researches GITs on other occasions. Are quite often diagnosed only after development of complications or malignant transformation. Happen single and multiple. There are diseases at which the quantity of polyps of a thick gut can reach several hundred or thousands of pieces. Usually such diseases have hereditary character. Treatment is carried out by experts in the field of a proktologiya, abdominal surgery and oncology.
Reasons of polyps of a thick gut
There are several hypotheses explaining emergence of polyps of this anatomic area. The most widespread is the theory according to which polyps of a thick gut are formed against the background of chronic inflammatory changes of a mucous membrane of intestines. Experts note that similar changes often arise owing to unbalanced irregular food, the use of fast food, a large amount of digestible carbohydrates, greasy, fried, salty, spicy and spicy food at a lack of fresh vegetables and fruit.
Such diet promotes decrease in peristaltic activity of intestines and increase in number of harmful connections in intestinal contents. Because of frustration of a vermicular movement contents move ahead on intestines more slowly, and harmful substances long contact to an intestinal wall. This circumstance is aggravated with the increase in density of kalovy masses caused by absorption of liquid from too slow moving intestinal contents. Firm fecal masses injures an intestines wall at the movement. Everything listed causes a chronic inflammation of a mucous membrane of a gut.
Along with the theory of inflammatory changes, there is a theory of violations of an embryogenesis explaining formation of polyps of a thick gut with failures in process of pre-natal development of an intestinal wall. Some syndromes which are followed by formation of polyps have the hereditary nature. Polyps of a thick gut are quite often combined with other diseases of a gastrointestinal tract. Except the listed risk factors and possible reasons of development of polyps scientists point to negative impact of addictions (smoking, abuse of alcohol), a hypodynamia and an adverse ecological situation.
Classification of polyps of a thick gut
There are several classifications of polyps of this anatomic area. Taking into account a form allocate the polyps of a thick gut similar to a mushroom, with a narrow or wide leg; the educations reminding a sponge; polyps in the form of a bunch and in the form of dense knot.
Taking into account quantity distinguish:
- Single polyps
- Multiple polyps – groups of the knots which are localized in one or different departments of a large intestine
- Diffusion family polyposes – the hereditary disease which is followed by formation of hundreds or even thousands of polyps of a thick gut which usually are rather evenly distributed on intestines.
Taking into account morphological structure allocate:
- Ferruterous (adenomatozny) polyps of a thick gut. Are the most widespread type of polyps, are found in a half of patients. Represent dense pinkish or reddish hyper plastic growths of a ferruterous epithelium, usually fungoid form, is more rare – branching, creeping on a mucous membrane. Average diameter of adenomatozny polyps makes 2-3 cm. Educations are not inclined to an ulceration and bleeding. Can malignizirovatsya.
- Ferruterous and fleecy (adenopapillyarny) polyps of a thick gut. Are diagnosed for 20% of patients. Represent a transitional form between ferruterous and fleecy educations. Can .
- Fleecy (papillary) polyps of a thick gut. Come to light at 14% of patients. Represent the knots or creeping educations having saturated red color because of a large number of blood vessels. Can reach 3-5 and more see. Fleecy polyps izjyazvlyatsya often and bleed, formation of sites of a necrosis is possible. Have high tendency to a malignization.
- Hyper plastic (metaplastic) polyps of a thick gut. Come to light at 75% of patients. Represent the soft knots which are slightly towering over mucous. Diameter of educations usually does not exceed 5 mm. Are not inclined to an ozlokachestvleniye.
- The cystous granulating (juvenile) polyps of a thick gut. Treat anomalies of development. Are diagnosed at children's and youthful age. Often single, usually have a leg, can reach the big sizes. Are not inclined to a malignization.
Several types of polyps can be found in one patient. There are also pseudo-polyps – the growths of a mucous membrane on appearance reminding intestines polyps. Are formed at a chronic inflammation. Have no tendency to an ozlokachestvleniye.
Symptoms of polyps of a thick gut
At most of patients the clinical symptomatology is absent, polyps incidentally are found when carrying out tool researches of a large intestine. At some patients with polyps of a thick gut the aching, holding apart or skhvatkoobrazny pains in side and lower departments of a stomach disappearing or weakening after the act of defecation are observed. Frustration of a chair in the form of diarrhea, locks or their alternation can come to light. At the fleecy polyps of a thick gut located in the lower departments of intestines, patients can report about slime and blood in fecal masses.
At other types of polyps this symptom usually does not come to light due to the lack of tendency to bleeding and formation of slime. Highly located fleecy polyps of a thick gut can bleed and emit slime, but when passing on intestines of impurity are partially processed, partially mix up with a stake therefore visually, as a rule, are not defined. Blood loss volume at bleedings from polyps insignificant, however frequent repetition of such bleedings can become the reason of development of anemia.
In some cases large polyps of a thick gut block a gleam of intestines and provoke development of intestinal impassability, the shown intensive pains of skhvatkoobrazny character, nausea, vomiting, an abdominal distension, lack of a chair and gases. Similar states demand performing urgent surgery. Perhaps ozlokachestvleny polyps of a thick gut with development of a colorectal cancer, germination of the next bodies, formation of limfogenny and hematogenic metastasises.
Diagnostics of polyps of a thick gut
The diagnosis is exposed taking into account clinical signs, data of fizikalny survey, a rectal research, laboratory and tool techniques. At a palpation of a stomach morbidity in the field of defeat comes to light. The result of the analysis a calla on the hidden blood at polyps of a thick gut can be both positive, and negative. Irrigoskopiya demonstrates existence of single or multiple defects of filling, however this technique is rather effective only at polyps more than 1 cm in size. A rectal manual research informatively only at a low arrangement of polyps of a thick gut.
For survey of a rectum and overlying departments of intestines use endoscopic methods – a rektoromanoskopiya or a kolonoskopiya. Procedures allow to visualize polyps of any size, to define their quantity, a form, diameter and localization, to reveal bleeding, and educations, and also to receive fabric samples for a histologic research. In some cases at suspicion on polyps of a thick gut for specification of the diagnosis also use KT which gives the chance to receive three-dimensional pictures of the large intestine filled with contrast agent.
Treatment of polyps of a thick gut
The only way of treatment is surgical removal of polyps. At small educations without signs of a malignization use of the sparing endoscopic techniques is possible. Operation is performed during a kolonoskopiya. Enter the endoscope with a special loop into intestines, throw a loop over a polyp of a thick gut, move to its basis and delete knot, at the same time carrying out electrothermic coagulation of the bleeding basis. Intervention is well transferred by patients and does not demand hospitalization. Working capacity is restored within 1-2 days.
Polyps of a thick gut of the big sizes too sometimes delete in the endoscopic way, however at similar operations the risk of development of complications (bleeding, perforation of a large intestine) increases therefore such interventions have to be carried out only by skilled endoscopic surgeons using the modern equipment. Also the resection of large polyps of a thick gut with use classical surgical the technician is possible. After a laparotomy the surgeon opens a large intestine in a polyp arrangement zone, excises education, and then takes in a gut. Such operations are performed in the conditions of a hospital.
At multiple polyps of a thick gut, educations with signs of a malignization and the polyps which were complicated by intestinal impassability and a necrosis of a wall of a gut the resection of an affected area of intestines can be required. The volume of a resection depends on a look and prevalence of pathological process. Hereditary family polyposes, belonging to the category of obligate precancers, is the indication to a subtotal kolektomiya with formation of a kolostoma. After carrying out surgeries by the patient carry out bandagings, appoint analgetics and antibiotics.
The forecast at uncomplicated polyps of a thick gut without ozlokachestvleniye signs favorable. In other cases the result of treatment is defined by a condition of the patient and weight of pathology. After removal of polyps patients have to be under observation of the gastroenterologist, proctologist or oncologist. Regular endoscopic researches for timely identification of a recurrence are shown. Duration of observation and frequency of a kolonoskopiya depend on a type of polyps of a thick gut.