Polyps of a rectum and the anal channel – the good-quality opukholevidny educations proceeding from mucous membranes of anorektalny area. Often develop asymptomatically, can be shown by an itch, anal discomfort, pain, bleeding owing to formation of an erosion. Infection of polyps leads to emergence of anal cracks, a paraproktit. Treat precancer diseases of a rectum, are capable therefore they are subject to obligatory removal.
The polyp represents the tumoral education fastening a leg to a wall of hollow body. Polyps can be created in any hollow body of a gastrointestinal tract and are quite widespread pathology. Rectum polyps – good-quality educations on a pryamokishechny wall. Can be single and meet groups. Polyps of a rectum can be found in persons of any age including at children. Hereditary (family) polyposes (presence of polyps at close relatives) it is often inclined to an ozlokachestvleniye.
Men suffer polipozy by one and a half times more often than women. According to data of researches of the American Association of Cancer diseases among people 45 years are more senior about 10% suffer from intestines polyps. At 1% of patients polyps ozlokachestvlyatsya. In case of early identification of signs of an ozlokachestvleniye (bleeding) and timely medical assistance the forecast considerably improves (84% of survival).
Classification of polyps
Polyps of a rectum classify by quantity and distribution: a single polyp, multiple polyps (groups of educations in various departments of a large intestine) and diffusion family polyposes.
Polyps are distinguished on morphological structure: ferruterous, ferruterous and fleecy and fleecy, hyper plastic, cystous granulated (juvenile), fibrous. Besides, allocate pseudo-polyposes - growths of a mucous membrane as polyps at a chronic inflammation. The clinical diagnosis also includes information on existence or lack of a malignization (ozlokachestvleniye).
Etiology and pathogenesis of polyps
Thoroughly the etiology a polypose is not studied now. There are several assumptions of an origin and mechanisms of formation of polyps in digestive bodies. The most widespread theory of development a polypose of a large intestine assumes that the major pathogenetic factor of emergence of polyps is the chronic inflammation of a mucous membrane of an intestinal wall. In confirmation of this theory it is possible to bring such facts as the diseases of intestines of inflammatory character which are available in the anamnesis of many patients with polyps, the most widespread localization of polyps in places, anatomic inclined to the increased injury and irritation stagnant contents of intestines, and also the inflammation of polyps and an adjacent mucous membrane which are available often. It is experimentally confirmed that the long irritation of an internal wall often causes polyposes.
In addition, among the factors promoting growth of polyps It should be noted adverse influence of an ecological situation, tendency to a hypodynamia, improper feeding (an unbalanced diet, irregular meals, abuse of alcohol, the products irritating a mucous membrane of a digestive tract).
Dependence of incidence polipozy a large intestine and pathologies of vessels, a divertikulyarny disease, malignant new growths, and also inflammatory diseases of a gastrointestinal tract is noted. According to the embryonic theory, polyps are a consequence of violation of formation of intestinal walls and a mucous membrane of a digestive tract in the antenatalny period. Besides, genetic predisposition to a polypose is noted.
Symptoms of polyps of a rectum
Polyps of a rectum have no specific clinical manifestations which could indicate this pathology rather surely. Existence and expressiveness of symptomatology depends on the sizes of polyps, their quantity, an arrangement, morphological structure, and also the available or absent malignant growth. In addition, the clinical picture often is followed by symptomatology of the accompanying pathologies.
Usually polyps are found at an endoscopic research of intestines concerning other diseases. The large polyp can be shown by allocations (mucous or bloody) from back pass, feeling of discomfort, presence of a foreign matter at back pass. There can be a morbidity in the lower part of a stomach, podvzdoshny area.
Polyps often cause violations of peristaltic activity of intestines, promoting emergence of locks or ponos. Locks – the most frequent investigation of polyps as their presence at a gleam promotes partial intestinal impassability. Bleeding from back pass is a dangerous sign and demands the immediate address to the doctor as also oncological pathology which early detection promotes more successful treatment can be his cause. Belly-ache at polyps most often demonstrates accession of inflammatory process.
Diagnostics of polyps of a rectum
The vast majority of the revealed malignant tumors of a large intestine is a consequence of an ozlokachestvleniye of polyps. Thus, identifications the polypose is the indication to regular inspection of the patient at the proctologist regarding a malignization of polyps. Early identification of malignant growth in polyps of a rectum promotes successful removal of a tumor and the subsequent recovery in 90% of cases.
It is possible to find polyps of the anal channel and terminal department of a rectum at a manual research of back pass. Besides, this research allows to reveal or exclude other pathologies (hemorrhoids, rectal fistulas, anal cracks, cysts and tumors of pararectal cellulose). At men the manual research also gives an idea of a condition of a prostate.
Informative tool research of a rectum is the rektoromanoskopiya allowing to examine an internal wall of intestines on height of 25 cm from back pass. In most cases polyps arise in direct and sigmovidny guts and are found by means of a rektoskop. The kolonoskopiya allows to visualize walls of all large intestine. These techniques are optimum concerning identification of polyps, and also promote a detailed research of a mucous membrane and detection of the accompanying intestines pathologies.
Also the irrigoskopiya allows to reveal polyps more than 1 cm in the top departments of an obodochny gut (a radiographic research of a large intestine with contrast substance). At identification during endoscopic inspection of polyps, the fence of a bioptat is made for a further cytologic and histologic research.
Among laboratory techniques it is also worth noting the hidden blood test which is made at suspicion of intestines pathology in kalovy masses. Modern techniques of visualization of a condition of internals: a magnetic and resonant and computer tomography, can also promote detection of polyps of a large intestine.
Polyps of a rectum need to be differentiated with a number of pathologies of bodies of a small pelvis:
- the lipoma is characterized by localization in a submucous layer of the right half of an obodochny gut, but can sometimes extend on all obodochny gut and grow to enough large sizes;
- tumors of neepitelialny character (usually larger and not having legs): myoma of the big size (a tumor of a muscular layer) can cause difficulty of passability of intestines, but is quite rare pathology, angioma - the vascular tumors which are characterized by high tendency to bleeding meet more often;
- actinomycosis of an obodochny gut (the most frequent localization – a blind gut);
- the disease Krone (usually pathological process is localized in the top departments of a large intestine, at a X-ray analysis the gaustration is expressed) can be shown psevdopolipozy;
Major importance in differential diagnostics of polyps of a large intestine has a histologic research.
Treatment of polyps of a rectum
Polyps are not subject to conservative treatment. Removal of a polyp of a rectum is made or during endoscopy (if the sizes and an arrangement of a polyp allow), or a surgical way. Low located polyps are removed transanalno.
The small polyps revealed during a kolonoskopiya delete by an elektroekstsiziya during the endoscopic procedure (the leg of a polyp is covered a loopback electrode and press). Larger educations delete in parts. The polipektomiya can sometimes be complicated by bleeding and perforation of an intestinal wall. After removal polyps are exposed to a histologic research.
In case of detection during the research of cancer cells the question of a resection of an affected area of intestines is raised. Family diffusion polyposes treat by means of a total resection of a large intestine and the subsequent connection of the free end of a podvzdoshny gut with back pass. Only such treatment yields result at a combination diffusion a polypose (adenomatosis) with tumors of other fabrics and osteomam of cranial bones (Gardner's syndrome).
Forecast and prevention of polyps of a rectum
Timely identification and removal of polyps promotes in most cases recovery. Cases of a recurrence are frequent (usually not earlier than in 1-3 years) therefore they after removal of large polyps in a year make a control kolonoskopiya, endoscopic inspection is also recommended regular (each 3-5 years). Tendency to an ozlokachestvleniye of a polyp is directly connected with its amount and the number of educations. Large multiple polyps malignizirutsya much more often (the risk of an ozlokachestvleniye reaches 20%). It is especially inclined to regeneration in cancer family polyposes.
There is no specific prevention of polyps now. For decrease in risk of their emergence the balanced food, active lifestyle, timely identification and treatment of diseases of a digestive tract is recommended. Early identification of polyps of a rectum is the most important measure of prevention of cancer of rectum.