Divertikulyarny disease of a large intestine
The Divertikulyarny disease of a large intestine is a disease at which multiple protrusions of a wall of a thick gut are formed, the inflammation in the field of diverticulums is sometimes observed. The course of a divertikulyarny disease is followed by stomach spasms, locks, nausea, general intoxication. Possible complications are bleedings, peritonitis, intestinal impassability. Inspection includes carrying out a kolonoskopiya, irrigoskopiya, barium passage X-ray analysis. Tactics of treatment depends on expressiveness of symptomatology and can be conservative (a diet, antibiotic treatment, spazmolitik) or surgical (a resection of the site of a gut).
Divertikulyarny disease of a large intestine
Diverticulums of a thick gut represent the small educations which in fact are (pocket) stretched outside by the site of a wall of a large intestine. They arise owing to restretching of the weakened sites of a wall of a gut with an excessive pressure in it. As a rule, it is shown by belly-ache (most often in the left part). Intestines diverticulums quite often inflame as are the convenient place of reproduction of pathogenic bacteria. At the same time it can be noted temperature increase of a body and symptoms of the general intoxication. Frequency of incidence of a divertikulyarny disease can reach 20% of the population. Among elderly people (60-80 years) incidence makes up to 40-50%. Up to forty years the disease develops seldom, occurs equally equally both at men, and at women.
Formation of diverticulums is possible in any department of a digestive tract (for example, a congenital state – Mekkel's diverticulum – settles down in a terminal part of a small intestine), but most often diverticulums are formed in a large intestine (in particular in a sigmovidny gut) that is connected with features of an anatomic structure of a wall of a large intestine. Complications of a divertikulyarny disease can threaten life of patients.
Reasons and risk factors
The most significant factor of development of a divertikulyarny disease – the diet poor in vegetable cellulose. In this regard the increased incidence divertikulezy in the developed countries where most of the population eats food rich with cellulose in much smaller quantities is noted.
Cellulose is a part of vegetables, fruit and cereals. It promotes a softening of a chair and easier transit of a himus on intestines. At a lack of cellulose of a diet tendency to difficulties of depletion of intestines, locks develops. Frequent locks promote increase in pressure in intestines. In places where there is a weakening of an intestinal wall as a result of increase in intra intestinal pressure, there are protrusions. Over time, constant protrusions of an intestinal wall which can become the center of reproduction of bacterial flora are formed.
In a clinical proktologiya the divertikulyarny disease of a large intestine is systematized taking into account features of a current and subdivided into an asymptomatic divertikulez, , proceeding with clinical manifestations and with complications. Such classification allows to carry out adequate assessment of a condition of the patient, to choose the correct tactics of treatment and to estimate the forecast.
Symptoms of a divertikulyarny disease
Most often the long time proceeds asymptomatically, however at some patients periodic belly-aches as spasms can be noted. Often tendency to locks and increase in a stomach comes to light. At development of a divertikulit there is belly-ache, most often in its left part, morbidity at a palpation, nausea, vomiting, a lock. Quite often body temperature increases, the fever, weakness, a headache (symptoms of the general intoxication) is noted. Weight of a current and expressiveness of clinical symptoms depends on extent of damage of intestines and the available complications.
The Divertikulyarny disease of a large intestine is dangerous by development of complications: bleedings from diverticulums, perforation of an intestinal wall, abscesses of intestines and peritonitis, formation of fistulas. Besides, promotes development of intestinal impassability.
Bleeding at a divertikulyarny disease arises quite seldom, but can be very plentiful. Long hidden bleeding leads to development of anemia. Plentiful bleeding can demand the emergency surgical intervention.
The perforation of a wall of intestines and exit of contents in an abdominal cavity leads to development of peritonitis, a dangerous complication, the life-endangering patient. At perforation of an intestinal wall the emergency surgical treatment is shown. Removal of an affected area of intestines and sanitation of an abdominal cavity is made. Postoperative treatment includes an antibiotic treatment course.
The inflammation of a diverticulum can promote development of a purulent complication - abscess. It is possible to cure small abscesses conservatively, applying antibiotics of a broad spectrum of activity. If large abscess is revealed, or antibiotic treatment does not yield necessary result, make drainage of the purulent center (through a wall of a stomach enter a needle into an abscess cavity and pump out purulent contents). In certain cases it is necessary to make surgical intervention for opening and sanitation of abscess. Spread of a purulent infection on an internal wall of an abdominal cavity promotes development of peritonitis.
In certain cases in diverticulums fistula – the channel connecting intestines to others nearby the located bodies can be formed. At a divertikulyarny disease of a large intestine fistula between a thick gut and a small intestine, a bladder, stomach skin most often meets. Through svishchevy the course can extend an infection from the inflamed diverticulum. This complication is treated surgically - removal of fistula together with an affected area of intestines is made.
Infectious processes in a large intestine can lead to formation of cicatricial changes of a wall, narrowing of a gleam and as result, intestinal impassability. Resistant intestinal impassability with full blocking of contents in intestines is the indication to surgical intervention.
Diagnostics and inspection
Inspection of the patient with suspicion of a divertikulyarny disease of a large intestine is carried out by the doctor-proctologist, begins with collecting complaints, the anamnesis and fizikalny survey. At the same time features of a diet, tendency to locks, as a rule, come to light, at survey morbidity of a stomach and its increase can be noted. Confirmation of the diagnosis is made by means of tool and laboratory methods of diagnostics.
At blood test the general signs of an infectious inflammation can be noted (, a neytrofiliya, acceleration of SOE). At the internal bleeding taking place anemia can be noted. Intestines inflammation signs can be noted also in a koprogramma. Laboratory confirmation of the available inflammatory process at a divertikulyarny disease of a large intestine can speak about development of a divertikulit.
The main diagnostic method of identification of diverticulums in a large intestine is the kolonoskopiya. Besides, at a kolonoskopiya it is possible to reveal a source of internal bleeding and to exclude other diseases of a large intestine. Irrigoskopiya with contrast substance allows to reveal protrusions of an intestinal wall.
Treatment of a divertikulyarny disease
At the easy course of a disease for simplification of clinical manifestations observance of the recommended diet promoting pressure decrease in a large intestine most often suffices. Introduction to a diet of enough cellulose provide simplification of passing of intestinal contents on a digestive tract. However, if measures for correction of a diet are not enough, purpose of the medicines promoting elimination of locks () and the anesthetizing spazmolitichesky means at the expressed morbidity is necessary.
Development of a divertikulit demands anti-inflammatory and bactericidal therapy. Successful treatment of a divertikulit requires removal of load of a large intestine that is promoted by measures for change of a diet, and also is appointed a bed rest. In due time appointed antibiotic treatment course, as a rule, suppresses the developing infection. However, in certain cases conservative treatment can be unsuccessful or development of complications demands immediate surgical intervention.
Absolute indications to operation are: perforation of a thick gut with an exit of intestinal contents in an abdominal cavity, peritonitis, the progressing abscess, full intestinal impassability, massive bleeding, high probability of cancer of intestines. Besides, the indication to surgery is inefficiency of conservative treatment, periodic small internal bleedings, the expressed anemia, fistulas, a frequent retsidivirovaniye of a divertikulit. As a rule, make a resection of an affected area of intestines with the subsequent restoration of intestines by means of reconstructive operation.
Forecast and prevention
As the major etiologichesky factor of development of a divertikulyarny disease of a large intestine is the lack of cellulose of a diet, as prevention of this disease the regular use of vegetables, fruit, cereal cultures – the products rich with cellulose is recommended. In case of the divertikulez taking place it is necessary to observe strictly medical appointments on a diet and a way of life. You should not try to be treated independently at all. Self-treatment can lead to development of life-threatening complications.
Most often the divertikulyarny disease of a large intestine does not cause serious problems to the patients adhering to a diet. However, when progressing and a heavy current can promote development of complications which without the due emergency help can lead to a lethal outcome.
Other party of danger which is represented by a divertikulyarny disease of a large intestine is advanced age and, as a rule, the weakened general condition of an organism promoting a frequent retsidivirovaniye of divertikulit. The repeated aggravation of inflammatory process occurs at 33% of patients. About 20% of patients after the treated bleeding note its repetition after a while.
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