Intestines polyps – the good-quality new growths coming from a ferruterous epithelium, towering over a mucous membrane of a gut, located on a leg or the wide basis. The majority of polyps have an asymptomatic current, however at achievement of the big sizes can be shown by symptomatology of intestinal impassability, signs of growth and an ulceration. At diagnosis major importance is attached to endoscopic techniques with a biopsy, also use a radiological method, the analysis a calla on the hidden blood. Because of high risk of a malignization all polyps of intestines recommend to delete in the operational way.
Polyps of intestines are very widespread pathology of digestive tract. Frequency of occurrence of polyps in various departments of intestines considerably varies – the most part of new growths is located in thick and a rectum, much less often polyps reveal in a small intestine. Polyps of a duodenum are extremely rare pathology – reveal them no more than in 0,15% of all EGDS. In most cases the polyp of intestines is found unexpectedly during endoscopic inspection.
Scientists still did not develop the uniform theory of an origin of polyps of a GIT. Lack of a characteristic clinical picture, the general approach to treatment of polyps also is a big problem. Opinions of various authors concerning the choice of volume and tactics of treatment strikingly differ. Today most of surgeons incline to low-invasive endoscopic and surgical methods of removal of polyps of intestines, and conservative therapy is used only in quality of training to operation. It is connected with high risk of a malignization and a recurrence of polyps (approximately at 30% of patients). Many researches in the field of gastroenterology are sent to search for such methods of diagnostics which would allow to suspect and reveal a polyp at an early stage, before its transition to a malignant new growth.
Reasons of polyps of intestines
The exact reasons of formation of polyps of intestines are still not defined. Risk factors are: hereditary predisposition, bad ecology, low level of physical activity, improper feeding (large amount of fats and carbohydrates, lack of cellulose), intestinal dysbiosis, frequent locks, diverticulums and malignant tumors of intestines.
Scientists select three main theories of formation of polyps of intestines: theory of irritation, disregeneratorny theory, theory of an embryonic allotopia. If to follow the theory of irritation (inflammatory), polyps of intestines are an intermediate link between inflammatory diseases and cancer of intestines. According to the disregeneratorny theory, when forming sharp inflammatory process, or when traumatizing a mucous membrane of intestines regenerator processes are started. Every time after that in a mucous membrane at the microscopic level there are traces of violation of process of regeneration in the form of a thickening of a ferruterous epithelium. Normal after a while these processes are eliminated, however at too frequent start of regeneration pathological changes gradually collect, leading to formation of polyps of intestines. The theory of an embryonic allotopia considers intestines polyps as a product of the wrong embryonal development of his mucous membrane of which as a result of inflammatory processes and injuries and polyps are formed.
The intestines polyps localized in a duodenum meet extremely seldom – single observations of this pathology are described. Practically all patients with polyps of intestines of this localization undertook on operation with suspicion of a malignant tumor. Most often polyps are located in the field of DPK bulb (acid caused) – are formed at the patients having gastritis with the increased acidity; more rare around Oddi's (zhelche-caused) sphincter - at patients with cholelithiasis and cholecystitis. Among patients with polyps in a duodenum people of working-age (30-60 years) of both floors prevail.
Intestines polyps most less often come to light in a small intestine. In literature single descriptions of polyps of intestines meet this localization, and at a half of patients they are combined with polyps in other departments of a digestive step (a stomach, a large intestine). In initial departments of intestines (small intestine) polyps come to light usually at the age of 20-60 years, is slightly more often at women. Generally polyps have a ferruterous structure though also fibromatous, angiomatozny polyps of intestines meet; identification of both the single, and multiple polyps (located compact groups or diffuzno on all gut) is possible.
The most frequent localization of polyps of intestines is the thick gut. Such polyps of intestines at youthful age are formed, is more rare in children's or mature. Many authors speak in favor of hereditary predisposition to intestines polyps with localization in a thick gut. The most widespread theory of emergence of polyps in a thick gut is inflammatory. Single or multiple polyps of intestines of the specified localization come to light at 12-15% of the population after 40 years, making more than 70% of all good-quality new growths of a large intestine. At children and young men polyps of a thick gut come to light more often – at 26%. Approximately at 3% of patients polyps of intestines represent a precancer state at the time of identification. In 70% of cases polyps are localized in terminal departments of a large intestine (descending, sigmovidny, a rectum), other 30% are evenly distributed in the ascending, cross part of an obodochny gut, a hepatic and splenic corner. Special distinctions by gender are not revealed. Polyps of a rectum make 90% of all cases a polypose of a large intestine and at eight people from ten precede rectum cancer.
Symptoms of polyps of intestines
The intestines polyps located in a duodenum approximately in 67% of cases do not prove in any way. At achievement by a tumor of the big sizes of the patient pain, impassability of intestines and bleeding from an izjyazvlenny mucous membrane of a polyp begins to disturb. Pains can have various character, but are localized more often in an epigastriya, about a navel. The pain syndrome often is followed by feeling of overflow of a stomach, an eructation rotten, nausea. If the polyp of intestines obturirut a duodenum gleam, food begins to be late in a stomach, causing clinic of high intestinal impassability: pains become skhvatkoobrazny, there is vomiting the eaten food, at an auskultation of a stomach splash noise is defined. On a clinical picture it is not possible to establish the diagnosis of polyps of intestines in DPK as its symptomatology feigns a tumor of pilorichesky department of a stomach, the bilious courses or a small intestine.
The intestines polyps located in a small intestine usually have very terrible symptomatology as can lead to an invagination, perforation of a wall of a gut, intestinal impassability, a zavorot of a gut and profuzny bleeding. Very often polyps of a small intestine malignizirutsya. At initial stages of a disease intestines polyps with this localization can be shown by a meteorizm, nausea, an eructation, the dispepsichesky phenomena. Often skhvatkoobrazny pains which can extend from an epigastriya to podvzdoshny area disturb. At a polyp arrangement in initial departments of a small intestine emergence of unrestrained vomiting is possible. Large polyps of intestines can be shown by four groups of symptoms: sharp intestinal impassability (it is most often connected with an invagination, guts are more rare with an excess, zavoroty); growth and an ulceration of a polyp (bleeding at every third patient, the palpated tumor); the partial or alternating impassability of intestines; asymptomatic clinical picture.
The characteristic signs indicating existence of polyps in a large intestine do not exist. Besides, polyps of intestines of this localization are often formed against the background of other pathology, inflammatory process. The asymptomatic current of polyps of intestines is noted only in the presence of a single polyp of a thick gut no more than at 3% of patients. At the others the feeling of discomfort in intestines appears several years prior to deployment of a clinical picture of a polyp. Nearly 90% of patients note release of slime or blood during defecation (the below the polyp is located, the blood is brighter, mixes up with a kalovy masses less); every second notes alternation of ponos and locks, a combination of this symptomatology to tenezma. Against the background of diffusion a polypose a clinical picture so bright that can imitate heavy intestinal infection. Belly-aches, an itch and burning in a rectum and an anus are very often noted. Against the background of ponos and intestinal bleeding begins to suffer and the general condition of the patient – appears weakness, pallor, dizziness, exhaustion.
Diagnostics of polyps of intestines
The diagnostic program at intestines polyps usually includes various radiological techniques of a research, an endoscopic research, and also the analysis a calla on the hidden blood. It is possible to get a referral on inspection on consultation of the gastroenterologist, however for completion of diagnostics hospitalization in a hospital can be required.
The indication to consultation of the endoscopist and an ezofagogastroduodenoskopiya is suspicion on a polyp of intestines or a tumor with localization in a duodenum. During the research the endoscopic biopsy (it is contraindicated to patients with violations of coagulability of blood) is surely carried out, and at an opportunity – removal of a polyp. Radiological techniques, such as a barium passage X-ray analysis on intestines, are insufficiently informative at polyps of 12 perstny guts – statement of the correct diagnosis is possible in 11-45%. More exact results receive when carrying out a relaxation duodenografiya, MSKT of abdominal organs.
In identification of the polyps of intestines localized in a small intestine radiological techniques widely are used (they are effective in 93% of cases). The barium passage X-ray analysis is most widespread on a small intestine which allows to reveal defects of filling of intestines. Gives the chance to make a research more exact an intestines relaxation by means of spazmolitik, local introduction of contrast via the probe. It is necessary to differentiate such polyps of intestines with chronic enteritis, intestines tuberculosis.
For diagnostics of polyps of a large intestine use radiological (an irrigografiya, double contrasting) and endoscopic (a rektoromanoskopiya, a kolonoskopiya with a biopsy) methods, a manual research of a rectum, the analysis a calla on the hidden blood.
Treatment of polyps of intestines
All patients with suspicion on polyps of intestines are hospitalized in office of gastroenterology or surgery for carrying out inspection and treatment. After verification of the diagnosis tactics and volume of surgery is chosen. Conservative treatment of polyps of intestines is possible only in the presence of diffusion a polypose of all digestive tract, uncomplicated juvenile a polypose, and also as a temporary measure by preparation for operation and at the weakened elderly patients.
The only method of treatment of polyps of DPK is their removal. The endoscopic biopsy with removal of a polyp - a preferable method of surgery, allows to stop bleeding from izjyazvlenny mucous.
At identification of polyps of a small intestine of the small size on a leg the enterotomiya with removal of polyps is made. In all other cases the segmentary resection of a small intestine with a bryzheyka is shown. A postoperative lethality in the presence of polyps of intestines of this localization rather high – to 15% - that is caused by late diagnostics, development of an invagination and the poured peritonitis.
Treatment of the polyps of intestines localized in its disteel departments (a thick gut) also quick. Perhaps endoscopic removal of polyps (excision or electrothermic coagulation), a segmentary resection of a thick gut, and at diffusion to a polypose or a malignization – radical operation (a gemikolektomiya, a subtotal or total koloproktektomiya).
Forecast and prevention of polyps of intestines
The forecast of polyps of intestines in general favorable on condition of their timely identification and removal. It is necessary to remember what is long the existing, big, and also multiple polyps have the high potential of a malignization. More than in 30% of cases after removal of polyps of intestines the recurrence within several years therefore existence of polyps of intestines in the anamnesis demands annual passing of an endoscopic research is celebrated.
Prevention of polyps of intestines does not exist, the only way to warn a malignization of a polyp is regular screening inspection of all population after 40 years.