They are sac-like protrusions of the wall of the OC. Congenital diverticula develop due to a violation of histogenesis during embryonic development. Acquired diverticula result from protrusion of CO through defects in the muscularis propria (false diverticulum).

The muscle layer of the OC is most poorly expressed between the longitudinal muscle bands, therefore it is here that diverticula most often form. They are often localized where blood vessels enter the intestinal wall. The reasons that contribute to the occurrence of diverticula are inflammatory processes in the intestine, weakening its wall, and an increase in intraluminal pressure (constipation).

Diverticula have a neck 3-5 mm long and a body with a diameter of 0.5-1.5 cm. In terms of frequency, they occupy first place among diverticula of other parts of the gastrointestinal tract. OC diverticula were first identified by Morgagni in 1700.

Diverticulosis OK often occurs in people over 40 years of age, and this disease is more common with age. The bulk of patients (up to 80%) are people over 60 years of age (A.A. Shalimov, V.F. Saenko, 1987).

Diverticulosis often occurs in countries where the population consumes waste-free foods and large amounts of refined carbohydrates.

Almost 80% of patients have multiple diverticula. Any part of the OK is affected, but most often (68% of cases) the sigmoid OK (S.K. Malkova, 1973; Mianoglarra, 1961).

There are true, or congenital, and false, or acquired, diverticula of the OK. In the first case, the wall of the diverticulum consists of all layers of the intestinal wall, in the second it is devoid of the muscular layer, and the diverticulum is a hernia-like protrusion of the mucus and submucosal layer. Congenital diverticula are usually single and are found in the right half of the OC. Most diverticula of OK occur in adults and are acquired. The location of diverticula in relation to the circumference of the intestine is quite characteristic.

They never penetrate taenia. Most of them occur on the lateral walls of the intestine between the mesenteric and two antimesenteric taenia. A diverticulum consists of a narrow neck passing through muscle layer intestines, and an expanded body located outside the muscular coat.

For the formation of diverticula, in addition to the above factors, impaired OC motility and increased intraintestinal pressure (intestinal hypertension) are also important. In the occurrence of increased pressure in the intestine, the process of segmentation plays an important role, which normally contributes to the portioned movement of feces through the intestines. Intraintestinal pressure in closed segmentations and spasms of cavities can increase 10 times or more compared to normal. As a result of a prolonged spastic state, significant thickening of the muscles of the intestinal wall occurs.

Subsequently, a hernial protrusion of the CO occurs through weak areas of the muscle layer of the OC. As the diverticulum enlarges, its wall becomes depleted and atrophy occurs. Stagnant feces in the diverticulum cause the formation of erosions, ulcers, and development inflammatory process(diverticulitis).

Clinical picture

Asymptomatic diverticulosis, chronic diverticulitis (manifests vague nagging pain in the left half of the abdomen, flatulence, discharge of mucus and blood from the anus, persistent constipation, diarrhea, feeling of incomplete defecation), acute diverticulitis and complicated diverticulitis.

Acute diverticulitis occurs in approximately 20% of patients with diverticulosis. Manifested by sudden severe pain in the left half of the abdomen, stool retention, increased body temperature, increased heart rate, leukocytosis, muscle tension in the anterior abdominal wall, a symptom of peritoneal irritation, etc.

Acute diverticulitis can give a number of complications: peri-intestinal abscess, internal fistula (enterovesical, sigmoid-uterine, sigmoid-vaginal, rectal bleeding, often profuse, requiring surgical intervention).

Diverticula of the right half of the OC are much less common. They, as a rule, are true, solitary, and not prone to recurrence and perforation. When these diverticula become inflamed, sharp pains in the lower abdomen or throughout the abdomen, which after some time are localized in the right iliac region. Nausea, vomiting, loss of appetite, constipation or diarrhea may also occur.

An objective examination reveals muscle tension in the right iliac region. Body temperature rises, leukocytosis is observed in the peripheral blood. Clinically, such cases are very difficult to distinguish from acute appendicitis. Inflamed diverticula of the MC usually form so-called inflammatory tumors, which even during surgery are difficult to distinguish from MC cancer (A.A. Shalimov, V.F. Saenko, 1987). Against the background of diverticulitis, perforation of the diverticulum into the free abdominal cavity can occur (in 2-27%) with the development of peritonitis.

When perforation occurs in the retroperitoneal tissue, phlegmon develops. When perforation occurs in the tissue located between the layers of the intestinal mesentery, a paracolic abscess develops. Another complication of diverticulitis is the formation of abscesses in the closed cavity of the diverticulum. When an abscess breaks into the abdominal cavity, peritonitis develops, and an internal fistula develops into a hollow organ. Long-term diverticulitis leads to the occurrence of adhesions, which often results in the development of NK.

Bleeding (from arrosion of the arterial trunk located at the neck of the diverticulum) occurs in 3-5% of patients with diverticulum OK. Bleeding occurs suddenly, is often profuse and is manifested by general (weakness, dizziness, pallor, tachycardia, etc.) and local (admixture of altered blood in the stool) phenomena. Up to 30% of patients with bleeding are subject to surgical treatment. Before surgery, it is necessary to know exactly the location of the source of bleeding, for which colonoscopy is used.

Diagnosis diverticula, OK is determined based on the medical history, clinical picture and radiological data. RI using a barium enema and subsequent contrast is of primary importance in the diagnosis of diverticulosis. During irrigoscopy, diverticula are revealed as a rounded depot of barium suspension extending beyond the intestine. With double contrast, the remaining tightly filled diverticula are clearly visible against the background of the CO relief. With fistulas, narrow passages are identified that are located outside the intestinal lumen and communicate with its lumen.

Treatment

Indications for surgical treatment of diverticulitis include abscesses, cancerous degeneration of the diverticulum, and recurrent course of the disease.

The optimal operation is considered to be a one-stage resection of the affected area of ​​the intestine. It is considered advisable to combine these operations with OC myotomy, which leads to a decrease in intraluminal pressure. In case of bleeding, surgical treatment consists of suturing the bleeding vessel and intussusception of the diverticulum into the intestinal lumen or resection of a section of intestine. Mortality rate emergency operations reaches 20%. The use of the latter is considered acceptable in complicated forms of diverticulitis (free or covered perforation without symptoms of severe peritonitis, internal and external fistulas), when it is possible to connect the unchanged ends of the OK.

If you suspect that the anastomosis is unreliable, a relief fistula should be placed on the transverse OC. In the presence of an abscess, pronounced inflammatory changes in the intestinal wall, a two-stage surgical intervention is indicated (Hartmann's operation or resection with removal of both ends of the intestine in the first stage and restoration of intestinal patency in the second).

In case of profuse bleeding, the most radical operation is considered to be subtotal colectomy with immediate or delayed ileorectal anastomosis.

IN last years The principles of treatment of diverticulosis and diverticulitis with OK are being revised. In contrast to the classic formula “operate only for complications,” many are beginning to lean in favor of preventive surgery for diverticulosis. The purpose of the operation is to improve motor skills and eliminate changes in the muscle layer of the OC. This is done by myotomy.

There are several options for myotomy - longitudinal, multiple, transverse. Currently, compensated longitudinal and transverse colomyotomy is often used (Kenewell, 1977; Castrini and Papalardo, 1981).

Colon diverticula

Diverticular disease (diverticulosis) of the colon is a morphofunctional pathological process, the main symptom of which is the presence of hernial protrusions of the intestinal mucosa (diverticula) through defects in the muscle layer of the intestinal wall.

Descriptions of colon diverticula in the literature date back to the first half of the 19th century. D. Fleischmann (1815), G. Cruveilheir (1849), finding changes similar to diverticula on corpses, considered this a rather rare disease associated with constipation. Currently, colonic diverticulosis has become quite common in Europe and the USA. The disease occurs in almost 50% of those who consult proctologists and gastroenterologists, especially over the age of 60, and in almost everyone over the age of 80.

Diverticula are localized in different parts of the colon with different frequency. Diverticula are found isolated in the sigmoid colon in 30% of patients, in the descending colon - in 13%, most often diverticula occupy both of these sections - 38% of cases. Diverticulosis occurs much less frequently in other parts of the intestine: in the transverse colon - in 5% of patients, in the ascending colon - in 6%, in the cecum - in 3% of patients. Total damage to the colon is also quite rare - in 5% of cases.

Etiology and pathogenesis

The reason for the formation of diverticula is a decrease in the resistance of the intestinal wall to intestinal pressure. The leading role in the development of this pathology is the loss of elasticity and extensibility of the muscular structures of the intestinal wall, congenital or acquired weakness connective tissue, impaired intestinal motility, weakness of sections of the intestinal wall at the points where blood vessels pass, and others. There are certain anatomical prerequisites for the development of diverticula in the colon. These include: 1) the formation of the outer muscle layer in the form of three stripes (shadows), which weakens the intestine against internal and external influences; 2) the nature of the vascular architectonics - the presence of arteries and veins of perforators of the muscular frame, as a result of which places of least resistance are formed in the intestinal wall; 3) the presence of haustra, in which increased intraintestinal pressure can be generated.

Thus, colon diverticulosis is a multifactorial pathological process, in the development of which both local and systemic factors are important, leading to characteristic changes in the intestinal wall.

Classification

Attempts to classify diverticula of the gastrointestinal tract have been made since the end of the 19th century. There are both true (Meckel, Zenker) diverticula - consisting of all layers of the intestinal wall, and false - hernia-like protrusions of only the mucous and submucous membrane of the intestine through a weakened muscular layer. In practice, the most convenient is the clinical classification, which allows you to assess not only the condition of the intestine, but also to develop therapeutic tactics for diverticular disease.

1) Asymptomatic diverticulosis.

2) Diverticulosis with clinical manifestations.

3) Complicated diverticulosis:

a) diverticulitis;

b) peri-intestinal infiltrate;

c) perforation of the diverticulum;

d) intestinal fistula;

d) intestinal bleeding.

Asymptomatic diverticulosis is the incidental detection of diverticula during examination for other diseases. When “intestinal symptoms” appear, patients are assigned to the second clinical group, in which treatment is indicated. systemic therapy. The complicated course of diverticulosis requires hospitalization in a surgical hospital and individualized treatment tactics.

Clinical picture and objective examination data of diverticular disease of the colon

Diverticulosis long time may be asymptomatic or have minor clinical manifestations. Clinically expressed uncomplicated diverticulosis is manifested mainly by pain syndrome of various nature and intensity, as well as stool disturbances. Most often the pain is localized on the left side lower parts belly. They can be either spastic or constant aching in nature. As a rule, pain intensifies when the intestines are full of feces. After defecation, their intensity decreases. Abnormal bowel movements usually manifest as constipation. In addition, patients often complain of a feeling of incomplete bowel emptying and bloating.

Over time, the muscular layer at the mouth of the diverticula becomes thinner and is replaced by adipose tissue. Fecal masses stagnate in diverticula, which, against the background of dystrophy of the intestinal wall and loss of the barrier properties of the epithelium, lead to the development of inflammatory changes - diverticulitis (due to swelling of the mucous membrane, emptying of the diverticulum is disrupted; against the background of stagnation, favorable conditions for the development of pathogenic intestinal microflora). Diverticulitis is accompanied by constant abdominal pain and an increase in body temperature up to febrile levels. Attachment to the focus of inflammation of the mesentery of the sigmoid colon, greater omentum, surrounding organs forms a peri-intestinal infiltrate, which can be palpated, as a rule, in the projection of the sigmoid colon. Perforation of a diverticulum into the free abdominal cavity leads to the development of peritonitis, and into the mesentery of the sigmoid colon - retroperitoneal phlegmon. If an abscess opens onto the skin of the abdominal wall or a nearby hollow organ, then the result of suppuration is internal and external fistulas connecting the lumen of the colon to the skin, bladder, less often - the small intestine or vagina. Blood discharge in the feces occurs in 10–30% of patients with diverticulosis, but intestinal bleeding with diverticulosis is rarely profuse. With severe atrophy of the mucous membrane, traumatization by solid feces can lead to damage to blood vessels and the loss of a fairly large volume of blood during defecation and separately from feces. Based on the patient's complaints (of periodic pain, often in the left half of the abdomen, stool disorders), a pathology of the large intestine can be suspected.

Laboratory changes are not typical for uncomplicated colonic diverticula. With bleeding, anemia may occur; with diverticulitis or perforation, leukocytosis may occur. As instrumental methods diagnostics, X-ray (irrigoscopy) and endoscopic (fibrocolonoscopy) studies are used. With diverticulosis, according to irrigoscopy, the intestinal wall has an uneven contour and forms pouch-like protrusions with a narrowed base (orifice). The sizes of these protrusions range from 0.2–0.3 to 1–2 cm, most often they are localized in the sigmoid and descending colon (Fig. 175).

X-ray examination can reveal the displacement of parts of the colon or, on the contrary, their fixation due to a paraintestinal inflammatory process.

No less informative method Diverticulosis is detected by fibrocolonoscopy, which, in addition to determining the presence of diverticula, makes it possible to clarify the extent of inflammatory changes in the intestinal lumen, the location of diverticula and the condition of their mucous membrane (Fig. 176).

Rice. 175. Irrigogram.

Multiple diverticula of the sigmoid colon (indicated by an arrow) It must be remembered that colonoscopy against the background of diverticulitis can lead to perforation of the colon and should be used carefully, taking into account the clinic and irrigoscopy data.

Rice. 176. Diverticula of the colon during fibrocolonoscopy

Uncomplicated diverticular disease of the colon has to be differentiated from colitis, tumors, and irritable bowel syndrome. It is difficult to make an accurate diagnosis based on clinical symptoms alone. To clarify the nature of the pathology, colonoscopy and irrigoscopy are performed. With a complicated course of diverticulosis, the range of diseases with which a differential diagnosis must be made expands significantly. These are diseases of the colon such as tumors, Crohn's disease, ulcerative colitis, acute appendicitis. It is necessary to carry out a differential diagnosis with extraintestinal pathology: renal colic, adnexitis, peritonitis of unknown etiology. In complex diagnostic situations, it is advisable to use laparoscopy, which can be both a diagnostic and therapeutic procedure.

Treatment tactics depend on the stage of the disease. For example, with asymptomatic diverticulosis, accidentally discovered during examination, no special therapy is required. It is necessary to indicate to the patient that he is at risk of complications of the disease. Preventive actions should be aimed at normalizing stool through diet. For clinically pronounced diverticulosis, the treatment strategy includes a diet rich in plant fiber and fluid (up to 1.5–2.0 liters of fluid per day), stool regulation with laxatives, antispasmodics (for spastic phenomena). Correction of developing dysbiosis against the background of chronic impaired colon emptying is important, which is detected during stool examination and, if necessary, eubiotics are prescribed. In cases of complicated diverticulosis (diverticulitis, paracol infiltrate), the patient is hospitalized. For moderately severe symptoms of intoxication, it is prescribed Vaseline oil to soften stool, a slag-free diet with limited fiber. Broad-spectrum antibiotics and antispasmodics are indicated. In 90–95% of cases, bleeding can be stopped with conservative measures (hemostatic and infusion therapy, bed rest). If these measures are ineffective, to clarify the source of bleeding, selective angiography of the superior and inferior mesenteric arteries is indicated to localize the source of bleeding. Complications such as perforation of the diverticulum, ongoing bleeding, abscess formation, and the inability to exclude a malignant tumor are indications for emergency and urgent surgical treatment. Periodically occurring intestinal bleeding, chronic recurrent diverticulitis, colon fistulas, lack of effect from conservative treatment are indications for surgery. The decision in each specific case is made individually, depending on the nature of the pathology and the somatic status of the patient.

The extent of surgery for diverticular disease is determined by the nature of the disease and its complications. Most often, resection of the colon segment most affected by diverticula or the area of ​​complications (perforation, infiltration, fistula, etc.) is used. To choose a specific surgical intervention The following factors influence: the prevalence of diverticula, the presence of inflammatory changes, age and general condition of the patient. With inflammation of the intestine (diverticulitis) there is high risk failure of the colonic anastomosis due to trophic changes in the intestinal wall. Therefore, it is often necessary to abandon the formation of a primary anastomosis and divide the surgical treatment into several stages: first, perform a resection of the altered intestine and apply a colostomy, and then after 3–4 months restore the continuity of the colon.

Crohn's disease

Crohn's disease is a chronic relapsing disease of unknown etiology, characterized by transmural granulomatous inflammation with segmental damage to different parts of the digestive tract. The disease was first described by the American physician W. V. Crohn in 1932. The pathology is typical for industrialized countries and mainly urban populations. Crohn's disease affects predominantly young people (the average age of those affected is 20^10 years), which makes it a socially significant disease. Men and women get sick with approximately the same frequency. The prevalence of the disease in different regions of the world varies widely - 20-150 cases per 100,000 population, reaching maximum rates in the Scandinavian countries, North America, Canada, and Israel. The annual increase in incidence in Europe is 5-10 cases per 100,000 inhabitants. The inflammatory process in Crohn's disease is localized primarily in the intestines, although all parts of the gastrointestinal tract can be affected, including the esophagus, stomach, oral cavity, and tongue. Crohn's disease with lesions is distinguished ileum(terminal ileitis) – 30–35%; ileocecal region - about 40%; colon, including the anorectal area – 20%; small intestine – 5‑10%.

Etiology and pathogenesis

Currently, there is no consensus on the etiology of inflammatory bowel diseases. By modern ideas, Crohn's disease is considered a polyetiological disease with a genetic predisposition, which allows the implementation of as yet unknown damaging agents. Bacterial antigens and their toxins, as well as autoantigens, can claim the role of the latter. The influence of microflora is considered from the standpoint of stimulation of inflammatory mediators by bacterial endotoxins - bacterial lipopolysaccharides, which are powerful chemotactic substances and cause migration of cellular elements to the site of inflammation. A significant role in pathogenesis appears to be played by genetically determined increased permeability of the intestinal wall, leading to a decrease in the function of the intestinal barrier to bacteria and their toxins. IN Lately Special attention Researchers are attracted by the concept of immunopathogenesis of chronic inflammatory bowel diseases. It can be considered proven that in Crohn's disease, local antibody production increases and a shift in the ratio of IgG and IgA secretion towards increased IgG production is detected.

Classification

Existing classifications mainly characterize the localization of the inflammatory process in the gastrointestinal tract, but do not reflect the diversity clinical course Crohn's disease. Abroad, the Bocus classification (1976) is most often used, according to which seven forms of Crohn’s disease are distinguished: 1st – jeunitis, 2nd – ileitis, 3rd – jejunoileitis, 4th – enterocolitis, 5th – granulomatous colitis, 6th – damage to the anal area, 7th – pan-regional intestinal damage involving the upper gastrointestinal tract (stomach, duodenum). In Russia, the classification proposed by V. D. Fedorov and M. X. Levitan (1982) has found the greatest use, according to which they distinguish: enteritis, enterocolitis and colitis.

Clinical picture and objective examination data

The clinical picture of Crohn's disease includes several main syndromes: intestinal syndrome; endotoxemia caused acute inflammation; extraintestinal manifestations; malabsorption syndrome. Clinical symptoms are determined by the morphological features of inflammation, localization and extent of the process. IN active phase Diseases with a detailed clinical picture include diarrhea, constant localized abdominal pain, and bleeding. Abdominal pain is a classic symptom of Crohn's disease and occurs in 85–90% of patients. Since inflammation in Crohn's disease is most often localized in the terminal segment of the ileum, this disease is characterized by recurrent pain in the lower right quadrant of the abdomen, and it can simulate a picture of acute appendicitis or intestinal obstruction (for which patients are sometimes mistakenly subjected to laparotomy, and if an incision is made in the right iliac region, then an appendectomy). Diarrhea occurs in 90% of patients and is usually less severe than with ulcerative colitis. When only the small intestine is involved in the process, the frequency of stool ranges from 2 to 5 times a day, and in cases of enterocolitis - up to 10 times. The consistency of stool is often mushy. However, in those patients in whom only the small intestine is significantly affected, the stool may be looser or waterier. Persistent diarrhea and protein catabolism lead to significant weight loss. The source of bleeding in Crohn's disease is deep ulcers and cracks in any part of the intestinal wall. Massive intestinal bleeding, which is considered a complication of the disease, occurs in 1–2% of patients. Increased body temperature is one of the main manifestations of Crohn's disease and is recorded during exacerbation of the disease in a third of patients. Fever is usually associated with the presence of purulent processes (fistulas, infiltrates, abscesses) or systemic complications of a toxic-allergic nature. Weight loss in Crohn's disease, as well as in ulcerative colitis, is associated with insufficient intake of nutrients due to lack of appetite and abdominal pain, impaired absorption and increased catabolism. Major metabolic disorders include anemia, steatorrhea, hypoproteinemia, vitamin deficiency, hypocalcemia, hypomagnesemia and other micronutrient deficiencies. Crohn's disease is often accompanied by autoimmune systemic organ damage. Arthropathy is the most common, occurring in approximately 40–60% of patients. Mono- and polyarthritis of large joints, arthralgia and arthropathy are usually observed small joints, ankylosing spondylitis and sacroiliitis are less common. Skin lesions most often manifest as erythema nodosum and pyoderma gangrenosum. The most typical complication of the mucous membranes is aphthous stomatitis. Osteoporosis, which has a mixed development mechanism, is common. As a rule, it is associated with impaired absorption and metabolism of calcium or is a consequence of steroid therapy, but an immunoinflammatory component in its development is also possible. Local complications Crohn's disease may include anal and perianal lesions (rectal fistulas, abscesses in the perirectal tissue, anal fissures), strictures of various parts of the intestine, infiltrates and abscesses in the abdominal cavity, external and internal fistulas. Life-threatening complications such as perforation and toxic dilatation of the intestine are rare in Crohn's disease.

Laboratory and instrumental diagnostics

Next laboratory parameters provide approximate information about the severity of the inflammatory process in the intestine: ESR, C-reactive protein, leukocytes, platelets, serum albumin, iron, blood coagulation parameters. Laboratory diagnostics Crohn's disease is based on the determination of antibodies to baker's yeast Saccharomyces cerevisiae(ASCA) class Js6, antibodies to the cytoplasm of neutrophils with determination of the type of luminescence, antibodies to Saccharomyces cerevisiae(ASCA) class JSA, antibodies to intestinal goblet cells, antibodies to the exocrine pancreas, antibodies to the cytoplasm of neutrophils class SgA. The information content of these tests in combination is up to 95%.

X-ray diagnosis of Crohn's disease is based on identifying the intermittent nature of intestinal lesions, involvement of the small and large intestines in the process, right-sided localization of the process in the colon with the formation of deep ulcers, fissures, internal fistulas, retroperitoneal abscesses with the formation of fistulas and blind sinuses in cases of involvement of the small intestine. intestines. Leading radiological symptom Crohn's disease is a narrowing of the affected area of ​​the intestine. The degree of narrowing is directly proportional to the duration of the disease. In some cases, the intestine narrows unevenly and eccentrically. Haustra in recent cases are smoothed out and take on irregular shape, as the process progresses, they disappear completely. The alternation of affected intestinal fragments with normal ones is considered very characteristic of Crohn's disease. The endoscopic picture of Crohn's disease is characterized by the presence of aphthoid ulcers against the background of an unchanged mucous membrane. As the process progresses, the ulcers increase in size and take on a linear shape. The alternation of islands of preserved mucous membrane with deep longitudinal and transverse ulcers-cracks creates a picture of a “cobblestone street” (Fig. 177).

A morphological examination of biopsy specimens reveals a transmural nature of inflammation, the presence of granulomas with characteristic Pirogov-Lanhhans type cells. Unfortunately, even with microscopy, an accurate diagnosis is established only in 23–30% of cases.

Table No. 1 Differential diagnostic criteria for nonspecific ulcerative colitis and Crohn's disease

Rice. 177. Endoscopic picture of Crohn's disease.

Crohn's disease must be differentiated from many diseases. Granulomatous lesions of the small intestine are often diagnosed as appendiceal abscess or acute appendicitis, since it is extremely difficult to differentiate them. Sometimes it is impossible to distinguish Crohn's disease from inflammation in Meckel's diverticulum and others acute diseases abdominal cavity. The most difficult differential diagnosis is Crohn's disease and ulcerative colitis, from which it differs in the absence of damage to the rectum in 50% of cases, deeper ulcers of the colon, asymmetry and intermittency of the process, and a tendency to form strictures and fistulas. The main differential diagnostic criteria for ulcerative colitis and Crohn's disease are reflected in Table 1 (G. I. Vorobyov, 2001, as amended). Treatment

The principles of conservative and anti-relapse treatment of Crohn's disease include anti-inflammatory, hormonal, and symptomatic therapy. Complex therapy is prescribed against the background of a special gentle diet with the exclusion of whole milk, fruits and vegetables, and the inclusion of lean meat and fish. The main medications are salazal preparations - sulfasalazine, mesalazine, salofalk and others. Corticosteroids are widely used and are generally highly effective for both systemic and local application. However, it should be noted that the use of hormonal therapy reduces the clinical manifestations of the disease, but does not improve the histological and endoscopic picture of the disease. In patients with increased psychological excitability, it is advisable to prescribe sedatives.

Surgical treatment of Crohn's disease, unlike ulcerative colitis, is not radical in nature, since granulomatous inflammation can develop in any part of the gastrointestinal tract. The goals of surgical treatment for Crohn's disease are to control complications and improve the quality of life of patients when this cannot be achieved medications. Regardless of the nature of the course of Crohn's disease, in approximately 60% of patients, due to the development of complications, there is a need for surgical treatment, especially in cases of damage to the colon and ileum. Ineffective corticosteroid and immunosuppressive therapy, even in the absence of complications, are also an indication for surgery - resection of the affected area. However, there is no guarantee that after surgery there will be no relapse in the anastomotic area or in any other place in the gastrointestinal tract, since natural course Crohn's disease continues even after surgery. The postoperative recurrence rate is 20–40% within 5 years after resection, with at least every third patient requiring reoperation.

Intestinal diverticula are sac-like protrusions of the walls of the large or small intestine, which have both a congenital (due to genetic pathology of connective tissues) and acquired (provoked by age-related weakening of the interstitial structures) nature.

A pathological process characterized by the formation of single or multiple diverticula is commonly called diverticulosis.

Diverticula of the small intestine belong to the category of fairly rare pathologies, occurring only in every hundredth patient and represented, as a rule, by Meckel’s diverticulum, consisting of tissue of the pancreas or stomach.

In the vast majority (more than 70%) of cases, multiple diverticula are localized in the left half of the large intestine. It has been established that diverticulosis progresses as a person ages:

• in young patients it is detected in 5% of cases;
• in people belonging to the age category from forty to sixty years, diverticula are found in 30% of cases;
• after eighty years of age, diverticulosis occurs in 70-80% of patients.

Diverticulosis of the large intestine is a real scourge of highly developed countries, whose inhabitants differ high level and long life expectancy. Doctors attribute this fact to a dramatic change in patients’ eating habits and their refusal to eat foods rich in plant fiber and coarse dietary fiber.

They explain the prevalence of pathology among patients over forty years of age by a decrease in the body’s compensatory potential or, in other words, its ability to withstand the constant influence of pathogenic factors.

Causes

The main factor contributing to the occurrence of intestinal diverticula (both congenital and acquired) is the weakness of the connective structures.

In patients with congenital connective tissue dysplasia, multiple diverticula appear on the walls of many internal organs(for example, intestines, Bladder, and etc.).

At first, the walls of congenital pathological protrusions (diverticula) consist of the same layers as the walls of the organs affected by them, but over time, atrophy of the contents contained in them occurs muscle fibers.

Acquired intestinal diverticula occur as a result of:

• Power supply errors. The most common mistakes in preparing a daily diet are irregular meals, the use of semi-finished products, and a complete refusal to eat fresh vegetables, fruits and foods rich in plant fiber.
• Chronic lack of vitamins (avitaminosis).
• Hypodynamic lifestyle.
• Developed obesity.
• Chronic constipation.
• All kinds of intestinal motility disorders.

Under the influence of any of the above factors, intraintestinal pressure increases, provoking protrusion of the mucous and submucosal tissues of the affected intestine between the muscle fiber structures, ending in the formation of a cavitary protrusion, the diameter of which does not exceed five centimeters.

Meckel's diverticulum, which affects the wall of the small intestine exclusively, deserves special mention. The cause of its occurrence is a congenital anomaly consisting of incomplete fusion of the umbilical duct.

As a result, a finger-shaped diverticulum is formed on the wall of the small intestine (half a meter from the ileocecal valve), connecting to the intestine with a wide anastomosis.

In some patients suffering from the duodenum, the appearance of single diverticula is observed, localized on the walls of this organ in the area of ​​the bulb or papilla of Vater. Cases of any other localization of small intestinal diverticula are extremely rare.

The typical location of large intestinal diverticula is the walls of the left half of the transverse colon and sigmoid colon. Forming two rows stretching along the mesentery, they are usually located one on each side.

Photo of diverticulitis of the large intestine

The reason for the age-related progression of diverticulosis of the large intestine is the complex effect of two factors: increased intraintestinal pressure and stagnation of feces, leading to a squeezing (pulsation) effect. As a result, every year many new protrusions form on the walls of the colon.

Classification

There are a large number of classifications of this disease, which are based on any one leading feature.

Depending on the degree of involvement of the layers of the affected organ in the process of formation of diverticula, they are divided into:

• True, which are bag-like protrusions of all structures (represented by muscular, mucous and submucosal membranes) forming the wall of the internal organ.
• False(or pseudodiverticula), formed by protrusion of tissues of the mucous membrane alone, protruding into the gaps between the structures of muscle fibers and therefore resembling hernias.

Depending on the origin, intestinal diverticula are:

• Congenital. With congenital diverticulosis, multiple protrusions of the walls are characteristic of many hollow organs. In combination with cholelithiasis and diaphragmatic hernia, intestinal diverticula are sometimes part of Saint's triad. Congenital diverticula that form during fetal development are usually true.
• Acquired. Occurring throughout life as a result of constant exposure to pathogenic factors, acquired diverticula in the vast majority of cases are false.

Pseudodiverticula, which after reaching a certain age appear in almost 80% of the world's population under the influence of multidirectional mechanical forces (depending on the mechanism of their formation), are:

• traction;
• pulsating.

The basis for the difference between traction and pulsation diverticula is the direction (either into the organ cavity or out) of the mechanical action.

The formation of pulsation diverticula occurs as a result of either a genetically predetermined failure of the muscle tissue of the affected organ (in this case, the mucous membrane bulges, forming something like a pouch), or due to strong mechanical stress.

The formation of traction diverticula is a consequence of prolonged mechanical stretching of the walls of hollow organs from the outside, observed during the formation of adhesions between the hollow organ and the tissues adjacent to it. As a result, chronic stretching of the outer wall structures occurs, fraught with the appearance of a traction diverticulum.

Pulsation and traction diverticula differ in both size and shape. Traction diverticula are funnel-shaped and relatively small in size; The shape of pulsation diverticula is sac-like, and their size is quite impressive.

Depending on the location, diverticulosis of the large and small intestines is distinguished.

According to the characteristics of the clinical course, intestinal diverticula are:

• asymptomatic;
• clinically obvious;
• complicated.

The video briefly shows what diverticulitis and diverticulosis of the colon are:

Symptoms of intestinal diverticula

The clinical picture of small intestinal diverticulosis is characterized by the presence chronic diarrhea and vague abdominal pain.

In the majority (more than 80% of cases) of patients, diverticula of the large intestine may not manifest themselves in any way for a long time. Their discovery, which occurred during an examination undertaken for other diseases, is often completely accidental.

The remaining part of the patients has a number of nonspecific symptoms reminiscent of functional intestinal disorders and presented by:

• Increased flatulence, accompanied by abundant discharge of intestinal gases.
• Colicky abdominal pain.
• Unsteady stool, characterized by constant alternation of constipation, diarrhea and periods of normalization. When examining the stool, it turns out that they have the appearance of balls immersed in mucus.

For some patients, mild symptoms may cause little or no inconvenience, while for others it significantly complicates life.

The localization of pain depends on the location of the diverticula. Patients with diverticulosis of the ascending colon complain of pain in the right iliac region, and patients with diverticulosis of the sigmoid colon experience pain in the left side of the intestine.

The entry of feces into intestinal diverticula is fraught with stagnation and the occurrence of irreversible changes in the tissues of the affected intestinal wall. The simultaneous activation of intestinal microflora gives impetus to the occurrence of diverticulitis - the most common complication of this disease.

Diverticulitis of the large intestine is a very serious disease that requires qualified treatment, since the lack of medical care can be fatal.

The clinical picture of diverticulitis is characterized by the presence of:

• Severe pain in the lower abdomen (especially in its left quadrant, in which the sigmoid and descending colon are located).
• Fever is a powerful physiological mechanism that mobilizes the body's defenses to fight the inflammatory process.
• Dyspeptic symptoms, lack of appetite, general weakness. All these signs are a manifestation of intoxication of the body by a complex of toxic substances formed during inflammation of diverticula.
• Diarrhea and increased flatulence.
• Pain in the perineum and when urinating (these symptoms are quite rare).

When an abscess occurs that provokes the formation of a rectovaginal abscess, female patients often experience a specific symptom consisting of the appearance purulent discharge from the vagina.

Perforation of a diverticulum with effusion of contents into the retroperitoneal space sometimes leads to pain in the leg located on the affected side.

Perforation of a diverticulum of the large intestine is accompanied by symptoms of an “acute abdomen”, extremely similar to the manifestations of acute appendicitis. This sometimes causes diagnostic errors that are revealed only during surgery, when instead of an inflamed appendix, the surgeon discovers a diverticulum with a perforated wall.

Complications

Complications of Meckel's diverticulum, localized on the wall of the ileum, are fraught with the development of:

• Littre's hernia;
• bleeding from the ulcerated part of the intestine;

Diverticula of the large intestine can become complicated, causing the occurrence of:

• Acute or chronic diverticulitis.
• Local peritonitis (inflammation of the peritoneum, limited to a small area and not extending beyond the organ that has become the focus of the inflammatory process), giving impetus to the development of adhesions and the formation of fistulas that can connect the cavity of the large intestine with the bladder, vagina and the surface of the skin.
• Intestinal bleeding.
• Increased bacterial contamination of the colon.
• Perforation and rupture of the thinned wall of the diverticulum, which is fraught with the entry of intestinal contents into the abdominal cavity and the development of an interintestinal abscess (a delimited abscess localized between the intestinal loops, omentum, mesentery and abdominal wall). In the most severe cases patients develop diffuse peritonitis. All of these conditions require immediate attention surgical operation.

Diagnostics

The difficulty in recognizing diverticulosis lies in the complete absence of specific symptoms of this disease. Most often, diverticula in the intestine are found accidentally, during studies aimed at excluding tumors in the intestine or searching for the causes of severe anemia.

Having suspected the presence of diverticulosis, the gastroenterologist will prescribe a comprehensive medical examination, providing for the implementation:

• General blood test. If the disease is present, blood characteristics will indicate anemia and the presence of inflammatory changes.
• Bacteriological examination of feces and coprograms. In patients with diverticulosis, the results of these tests will confirm the presence of increased bacterial load, digestive disorders and colon dysfunction.
• Plain radiography of the abdominal organs is a non-contrast diagnostic technique performed without prior preparation of the patient. Usually, plain radiography performed in the presence of emergency indications. Because the plain films taken during this procedure can reveal the presence of ruptures and perforations of hollow organs, this study is primarily prescribed for patients suspected of having complicated diverticulosis.
• Irrigoscopy (x-ray contrast examination of the structures of the large intestine) with double contrast. A radiopaque substance, a suspension of barium sulfate, is injected into the patient's intestines using an enema and air is supplied to help straighten the folds of the colon. Thanks to double contrast, inflammatory changes in the mucous membranes of the large intestine are visible throughout its entire length.

The use of endoscopic diagnostic techniques is permitted only after relief (elimination) of the symptoms of inflammation.

After consultation with an endoscopist, the patient may be prescribed the following procedure:

• Colonoscopy is a diagnostic examination of the internal lumen of the large intestine using a special flexible device - a fiber colonoscope. During the procedure, an optical probe inserted through the anal canal is carefully advanced into distant parts of the colon, while introducing air into it to help straighten the intestinal lumen. Using colonoscopy, you can not only assess the condition of the large intestine along its entire length, but also take photographs of pathological areas, remove a number of tumors and take tissue samples (biopsy) for subsequent histological examination.
• Sigmoidoscopy – diagnostic study, which consists of examining the lumen of the rectum and lower third of the sigmoid colon using an optical device - a sigmoidoscope. Before starting the procedure, the patient takes a knee-elbow position or lies on his left side, tucking his knees to his stomach. Having inserted the sigmoidoscope into the anal canal, the doctor begins to advance it into the distal sigmoid colon (simultaneous air supply is mandatory). This procedure also makes it possible to perform a biopsy (punch or brush) to morphological research taken tissues.

Intestinal diverticulosis must be differentiated from a number of diseases, since similar clinical manifestations have:

• acute appendicitis;
• hypochromic anemia;
• pseudomembranous colitis;
• ectopic (ectopic) pregnancy;
• ischemic colitis;

To implement differential diagnosis it is necessary to carry out:

• ultrasound examination;
• computed tomography;
• multislice computed tomography of the abdominal organs.

How to treat intestinal diverticula?

Patients with uncomplicated intestinal diverticulosis receive treatment in the gastroenterology department. The occurrence of dangerous complications is an indication for their transfer to a surgical hospital.

Patients with acute or worsened chronic diverticulitis, the signs of which are:

• severe fever;
• symptoms of intoxication;
• severe concomitant pathologies.

An indication for hospitalization is also advanced age (over 85 years). Patients with the “” clinic undergo urgent (emergency) surgery.

Treatment of intestinal diverticulosis is divided into conservative and surgical.

• Patients with asymptomatic diverticulosis do not require special treatment. Therapy for this condition consists only of following a special diet enriched with plant fiber and consistent with the principles of a healthy diet. To normalize intestinal function, doctors prohibit patients from uncontrollably taking laxatives and performing cleansing enemas. A good effect is achieved by moderate but regular physical activity, which helps normalize intestinal motility and strengthen the muscle corset.
• Treatment of the manifest form of asymptomatic diverticulosis and acute recurrent diverticulitis consists of a combination of diet and drug therapy.

Diet

• Diet prescribed to patients with asymptomatic diverticulosis, involves the consumption of foods high in plant fiber (its daily norm must be at least 32 g/l). The exception is vegetables and fruits containing too coarse fibers (we are talking about pineapples, persimmons, radishes, radishes, turnips and raw cabbage). Products that contribute to increased gas formation should be completely excluded from the patient’s diet: watermelons, legumes, grapes, carbonated drinks. It is also necessary to avoid eating seeds, nuts, and grains that can accumulate in the cavity of the diverticula. Daily consumption of clean drinking water should be at least two liters.
• Diet of patients suffering from a manifest form of asymptomatic diverticulosis, requires the same high concentration vegetable fiber in food. In their daily diet must be fresh fruits, leafy greens, fresh vegetable dishes and salads, bran bread. In the presence of chronic constipation, it is recommended to use foods that swell in the intestines and attract fluid as laxatives. These properties are possessed by: plantain and flax seeds, seaweed.
• Diet of patients with acute recurrent diverticulitis provides for the need to use liquid food: puree soups, liquid porridges cooked in water and drinks represented by weak tea, jelly, compotes, decoctions and infusions of medicinal herbs.

Drug treatment

• The use of stimulant laxatives, as well as painkillers containing morphine, is contraindicated in the treatment of patients suffering from intestinal diverticulosis, since, by contributing to a further deterioration of intestinal motility, they only aggravate clinical picture illness.
• To improve the passage of processed food, patients are recommended to take osmotic laxatives, which help increase the volume of feces and speed up their movement through the intestines.
• Elimination of pain is achieved by taking antispasmodic painkillers.
• To improve digestion, patients are prescribed enzyme preparations.
• To reduce the symptoms of flatulence, medications containing simethicone are used.
• To eliminate diarrhea, patients take sorbents and drugs that have an astringent effect.

Patients with acute diverticulitis are subject to hospitalization and treatment in surgical department, where for seven to ten days they are given antibiotics (cephalexin or clindamycin), bacteriostatic sulfonamide drugs (most often sulfamethoxazole or biseptol) and metronidazole.

Along with the above drugs, they are prescribed medications that help restore the intestinal microflora.

The full course of treatment in a surgical hospital takes about three weeks. Patients discharged from the hospital are recommended to carry out a set of the same supportive therapeutic measures as for uncomplicated intestinal diverticulosis.

Operation

Surgical intervention is used in relation to patients in whom the aggravated illness has become a life-threatening condition.

• complete intestinal obstruction;
• profuse bleeding;
• perforation of diverticula;
• interorgan fistulas;
• abscess formation (attachment to the inflammatory process of a secondary infection, provoking the occurrence of an abscess).

Performing planned surgical intervention is also inevitable in the presence of diverticulitis and recurrent bleeding.

The most common type of surgery for intestinal diverticulosis is resection (removal) of the affected part of the intestine followed by an anastomosis to restore the continuity and smooth functioning of the intestinal tract.

There are two types of reconstructive operations for the application of interintestinal anastomoses:

• enteroenterostomy, during which the small intestine passes into the small intestine;
• enterocolostomy connecting the small intestine to the large intestine.

In the most severe cases, the surgeon imposes - performs an unnatural anus, bringing part of the colon to the anterior wall of the abdomen. This operation facilitates the outflow of feces and replaces the functions of a temporarily disabled or radically removed section of the colon.

After the patient’s condition has stabilized (this period can take from three months to six months), reconstructive surgery is performed aimed at restoring the continuity of the large intestine and physiological passage after resection of the affected area of ​​the colon.

Folk remedies

The use of traditional medicine (as a supplement to a gentle diet and drug therapy) is possible only after the approval of the attending physician.

• You can cope with flatulence with an infusion made from carrot seeds.. Fill a tablespoon of seeds with boiling water (at least 250 ml), cover the container with the infusion with a lid and leave for 15 hours. After straining, drink 1/3 cup three times a day. An infusion of dill seeds has a similar effect, only to prepare it you will need not a tablespoon, but a teaspoon of herbal raw materials.
• To eliminate pain, relieve spasms and fight inflammation you can make an infusion plant collection, consisting of equal parts of dill seeds, motherwort, crushed rose hips, chamomile flowers and stinging nettle leaves. Taking a tablespoon of the mixture and brewing it with a glass of boiling water, leave the saucepan with the infusion for two hours. After straining, the product is ready for use. Take 120 ml in the morning and at night. The duration of the course is four weeks.
• Bran, containing a large amount of plant fiber, must be on the table of a patient suffering from intestinal diverticulosis. They are best absorbed when mixed with kefir or yogurt (infusing for thirty minutes is enough). Starting with a tablespoon, the amount of bran should be gradually increased to 40 grams.

Prognosis and prevention

The prognosis for intestinal diverticulosis in most cases is favorable, although the development of severe life-threatening complications is not excluded.

In 25% of patients, diverticulosis worsens, giving way to diverticulitis. The effectiveness of its therapy at the time of the first exacerbation is at least 70%, while the success of treating the third episode of the disease does not exceed 6%.

Despite the lack of specific prevention of intestinal diverticulosis, the likelihood of its occurrence can be somewhat reduced by following a number of simple rules:

• It is necessary to eat properly, including fresh vegetables, fruits, all kinds of cereals and plenty of drinking water in your daily diet.
• If you feel the urge to defecate, you should immediately go to the toilet and empty your bowels. You should never push unnecessarily: excessive tension will only increase the risk of developing diverticulosis.
• Performing moderate physical activity, which promotes better passage of feces through the intestines and a decrease in intraintestinal pressure, is the best prevention occurrence of intestinal diverticula. The most useful are training the abdominal muscles, the tone of which has a beneficial effect on the functioning of the intestines.

Video program about intestinal diverticulosis:

Colon diverticulosis may resemble gastric and duodenal ulcers, and ascending diverticulosis may resemble acute appendicitis. It is important to recognize the symptoms of the disease in time and start treatment of colon diverticulosis. This disease is fraught with many complications. When a diverticulum perforates into the free abdominal cavity, peritonitis develops; when perforation into the retroperitoneal tissue, phlegmon develops; when perforation into the tissue located between the layers of the mesentery of the colon, a paracolic abscess develops. Purulent complications of the disease are especially dangerous.

Symptoms of progressive diverticulosis of the colon

Diverticulosis of the colon is a protrusion of the intestinal wall, having a neck 3-5 mm long and a body with a diameter of 0.5-1.5 cm. Most often, diverticula are located in the sigmoid colon and the left half of the organ (70-85%). As the diverticulum grows, its walls become thinner, the intestinal mucosa atrophies, creating conditions for perforation and other complications. Due to stagnation of feces, erosions, ulcers are formed, and an inflammatory process develops.

As the disease progresses (in 10-20% of patients), the symptoms of diverticulosis are as follows: pain in the left lower quadrant of the abdomen, aggravated by palpation. Usually a spastically contracted, painful intestine is felt.

In a more severe form of the disease, symptoms include unstable stool (constipation followed by diarrhea), decreased appetite, nausea, and occasionally vomiting. In this case, diverticulosis is accompanied by fairly intense abdominal pain, increased body temperature, and leukocytosis. Palpation of the abdomen in the affected area causes sharp pain and moderate muscle tension.

The mechanism of development of the disease diverticulosis of the colon

Patients have excessive contractility muscular membrane on nutritional and hormonal influences, contributing to an increase in pressure in the intestinal lumen, especially in the descending section and sigmoid. Increased contractions during diverticulosis lead to hypertrophy of the muscular lining of the intestine.

The movement of feces is carried out by coordinated segmental contractions that divide the lumen of the colon into chambers. The contraction of the chamber causes an increase in pressure in it, which helps push the contents into the next open, free chamber. After emptying, the pressure in the chamber decreases. A similar process occurs in the next chamber of the organ.

This leaves one end of the chamber open so that feces are pushed distally. If the distal end of the colon chamber is temporarily closed due to impaired intestinal motility, the pressure in the chamber decreases due to movement of the contents in the proximal direction. If some chambers in a given segment are closed at both ends, then contractions of the colon segment become mixing rather than propulsive, and the pressure in the chamber increases sharply, reaching 90 mm Hg. and more. High luminal pressure predisposes the mucosa and submucosa to protrusion through weak areas of the colon wall, similar to a hernia.

Such areas are usually the places through which the vessels penetrate the intestinal wall. As a result of the prolonged functioning of this mechanism, diverticulosis of the colon occurs.

Symptoms of different types of colon diverticulosis

Colon diverticula can be true or false.

Symptoms of true type colon diverticulosis

True diverticulosis is a hernia-like protrusion of all layers of the intestinal wall ranging in size from several millimeters to several centimeters. Symptoms of true diverticulosis are rare; they are innate.

Symptoms of false type colon diverticulosis

This is usually called multiple false diverticula. Colon diverticulosis of this type occurs in more than 50% of people over 40 years of age. The incidence increases with age. Diverticulosis occurs with the same frequency in women as in men.

With false diverticulosis of the intestine, only the mucous and submucosal layers, covered on the outside with a serous membrane, protrude through a defect in the muscular lining of the intestine. Diverticula - the main symptoms of diverticulosis of the colon - can be single or multiple.

Diverticulosis of the colon of various forms

It is customary to distinguish 3 main clinical forms illness:

diverticulosis of the colon without clinical manifestations, accidentally detected during examination of the intestines during a clinical examination;

diverticulosis with clinical signs;

diverticulosis accompanied by complications (diverticulitis, paracolic abscesses, internal and external fistulas, perforation, bleeding).

Diagnostic symptoms of colon diverticulosis

Diagnosis is based on medical history, results of X-ray and colonoscopic examinations. On radiographs obtained during irrigoscopy, the main morphological symptoms of colon diverticulosis - diverticula - are clearly visible. This is the name for small protrusions that extend beyond the outer contour of the intestine. They are clearly visible after emptying the intestine and inflating it with air.

During colonoscopy, some obstacle is felt when moving the instrument through the intestinal segment affected by diverticulosis, caused by spasm and hypertrophy of the wall. You can see the mouths of diverticula, inflammatory changes in the mucous membrane in the area of ​​their location. It should be remembered that rough colonoscopy and X-ray examination When diagnosed with diverticulosis of the colon, they are dangerous due to the possibility of perforation of the diverticulum.

Symptoms of complications of diseases of diverticulosis of the colon

A complication is abscesses that form in the closed cavity of the diverticulum. Breakthrough of the abscess into the intestine leads to recovery. When an abscess breaks into the abdominal cavity, peritonitis develops; when it breaks into a sealed hollow organ, an internal fistula develops. Most often, fistulas with complications occur between loops of intestine, bladder and vagina. External fistulas may occur. Vesicointestinal fistulas, manifested by pyuria, the release of gas or fecal particles during urination, usually form in men.

Bleeding as symptoms of colon diverticulosis

Bleeding, according to statistics, is observed in 3-5% of patients with diverticulosis. Bleeding occurs suddenly, is often profuse and is manifested both by general symptoms of blood loss (weakness, dizziness, pallor, tachycardia, etc.) and by the admixture of little changed blood in the stool (depending on the location of the diverticulum). The mechanism of this symptom is arrosion of the arterial vessel located at the neck of the diverticulum.

Long-term diverticulosis of the colon leads to an adhesive process, which often results in intestinal obstruction.

Treatment of colon diverticulosis with conservative and surgical methods

Conservative treatment of diverticulosis includes:

a diet rich in plant fiber,

antispasmodics,

prokinetics (Cisapride, Meteospasmil, etc.).

During treatment, you should refrain from prescribing laxatives, as they can cause an increase in pressure in the intestine.

Treatment of acute diverticulosis of the colon

Patients with symptoms of the disease accompanied by high temperature bodies and other signs of systemic response to inflammation syndrome are subject to hospitalization. In these cases, antibiotics are prescribed (a combination of Cephalosporin latest generation, Metronidazole and Gentamicin or another drug from the Aminoglycoside group), infusion therapy for the correction of water-electrolyte disorders and detoxification. As a laxative for constipation, treatment of diverticulosis of the colon involves the use of Lactulose (Normaze) 30 ml daily.

Surgical treatment of colon diverticulosis

Surgical treatment of the disease is carried out when:

diverticulum perforation,

intestinal obstruction,

internal fistulas,

massive bleeding,

severe diverticulosis with frequent episodes of recurrent exacerbations when conservative treatment fails.

Surgical treatment of colon diverticulosis involves removal of the affected area of ​​the colon (hemicolectomy, resection of the sigmoid colon). To reduce intraintestinal pressure, it is advisable to combine these operations with intestinal myotomy.

Surgical treatment of diverticulosis is prescribed in up to 30% of patients with bleeding (the bleeding vessel is washed, the diverticulum is invaginated into the intestinal lumen, if this is technically possible). The mortality rate during emergency operations reaches 20%.

Reasons for the development of the disease

The incidence of diverticulosis increased significantly in the 20th century. According to autopsy data, in 1910, diverticulosis of the colon was found in 5%, and in 1970 - already in 40%. This is explained, on the one hand, by better recognition of the disease, and on the other, by changes in living and nutritional conditions. In residents of Europe and the United States, diverticulosis is localized in the left half of the colon, and in residents of Asia - more often in the right. Consequently, colonic diverticulosis occurs due not only to the nature of nutrition, but also to other factors.

Factors in the development of the disease

Congenital diverticulosis develops as a result of disorders that occur during embryonic development. False diverticulosis of the colon is acquired. The reason for its appearance can be many factors:

food poor in fiber and waste, causing constipation and increased pressure in the colon, especially in the sigmoid and descending sections;

the presence of holes in places where vessels penetrate the intestinal walls;

inflammatory processes in the intestine, weakening its wall;

physical inactivity,

mechanical factor.

Lack of plant-based, fiber-rich foods is the most important factor development of the disease. Poor nutrition affects the peristaltic activity of the colon, which is under the control of myogenic, nervous and hormonal influences. Intestinal motor function is a complex process designed to move feces distally, absorb water, electrolytes and a number of other food components. Thus, dietary errors cause symptoms of diverticulosis.

Intestinal diverticulosis is an inflammatory pathology, which is accompanied by the formation of pouch-like protrusions in the area of ​​the intestinal walls. Diverticular bowel disease, as a rule, occurs in elderly patients, which is due to a decrease in the body's resistance to adverse factors.

Brief description of the disease

Diverticula form in the area of ​​the intestinal mucosa. In my own way appearance the neoplasms are somewhat reminiscent of a hernia. As a rule, they are localized in the intestinal area, although they can appear in the gastric cavity and esophagus.

The development of diverticular disease occurs according to to the following principle: due to poor nutrition and insufficient motor activity, normal intestinal motility is disrupted. As a result, the functioning itself is disrupted gastrointestinal tract. Frequent bloating and constipation lead to an increase in intestinal pressure, as a result of which painful neoplasms appear in the intestines. Additional risk factors include weak intestinal muscles.

In accordance with the established classification, diverticula can be either congenital or acquired. In the first case, their formation is associated with intrauterine development disorders. Acquired diverticula occur, as a rule, as a result of an unhealthy lifestyle and an unbalanced, irrational diet.

According to statistics, pathology of the large intestine occurs in 70% of patients diagnosed with diverticulosis. Disease of the small intestine is much less common.

Causes

According to experts, diverticula in the intestinal area can form under the influence of the following provoking factors:

• difficulty in defecation (frequent constipation);
• overweight;
• flatulence;
• bloating;
• intestinal infections;
• atherosclerosis of intestinal vessels;
• sedentary lifestyle;
• age category of the patient (over 60 years);
• hereditary predisposition;
• disruption of circulatory processes in intestinal vessels;
• intestinal diseases infectious nature occurring in a chronic form.

In addition, diverticula can also form due to improper, unbalanced nutrition of the patient. The development of this disease can be provoked by a lack of plant fiber in the daily diet, abuse of eggs, bakery products, fatty meats and fish.

According to doctors, in most cases, diverticulosis begins to develop in the presence of several provoking factors.

Signs of diverticulosis

In most cases, this disease does not manifest itself in any way and is asymptomatic for a long time. This is the main insidiousness of diverticulosis, because the patient turns to the doctor already in the late stages of the pathological process, in the presence of accompanying complications, which significantly complicates subsequent treatment.

In general, the following clinical signs are characteristic of diverticular disease:

• nausea;
• bouts of vomiting;
• flatulence;
• pain localized in the left side of the abdomen, with a tendency to intensify after eating;
• stomach upsets;
• diarrhea, periodically alternating with constipation;
• the appearance of mucous impurities in the stool;
• frequent urge to defecate, which may be false (tenesmus);
• feeling of incomplete bowel movement after bowel movement;
• intestinal bleeding;
• the appearance of bloody impurities in the stool.

Unfortunately, the symptoms of diverticulosis are nonspecific and can accompany a number of other diseases. In addition, according to statistics, in almost 80% of patients the disease occurs in a hidden, latent form for many years.

However, if any suspicious signs appear that characterize diverticulosis of the large intestine and other parts of the organ, it is strongly recommended to contact a specialized specialist for diagnosis and prescribing the optimal therapeutic course.

How dangerous is diverticulosis?

With diverticulosis, the intestine is severely affected, which can cause the development of such extremely dangerous and undesirable complications as:

• peritonitis;
• abscess;
• diverticulation perforation;
• phlegmon of the retroperitoneum;
• internal intestinal bleeding;
• fistulas;
• intestinal obstruction.

In addition, diverticular disease significantly increases the likelihood of the formation of malignant tumors in the intestine.

Quite often there are cases of inflammation in the area of ​​diverticula. This complication is called diverticulitis and is manifested by the following characteristic symptoms:

• increased body temperature;
• disorders of intestinal function;
• severe pain in the abdominal area;
• feverish condition;
• general intoxication of the body.

In order to prevent the development of such adverse consequences and minimize possible risks, it is recommended to treat diverticulosis with initial stages development of the pathological process. Despite frequent cases asymptomatic diseases, timely diagnosis is quite possible if a person takes responsibility for his own health and regularly undergoes medical examinations for preventive purposes.

In case of manifestation acute symptoms symptoms characteristic of diverticulitis, you should immediately seek professional medical help.

Diagnostic measures

To diagnose intestinal diverticulosis, as a rule, it is not enough to study the general symptoms and the results of the collected anamnesis. In most cases, patients are prescribed the following types of studies: colonoscopy, MRI of the intestine, etc.

In addition, the following may help to suspect the presence of this disease: laboratory research blood. With diverticulosis, the number of leukocyte and erythrocyte cells, as well as C-reactive proteins, increases in the patient’s blood.

Comprehensive diagnostics can identify the pathological process in the intestinal area at the most early stages its development, long before the appearance of characteristic symptoms.

Drug therapy for diverticulosis

For intestinal diverticulosis, treatment is predominantly medicinal. In most cases, patients are prescribed the following medications:

1. Antibiotics - Metronidazole, Piperacillin, Rifaximin.
2. Laxatives to normalize stool and facilitate bowel movements - Lactulose, Forlax.
3. Medicines belonging to the group of defoamers (Espumizan, Plantex) can be recommended if the patient suffers from symptoms such as flatulence and bloating.
4. Non-steroidal anti-inflammatory drugs (Sulfasalazine, Nimesil, Mesacol) - help eliminate inflammatory processes in the intestinal area.
5. Painkillers, antispasmodics (Drotaverine, No-shpa) are recommended for severe pain in the abdominal area.

It must be remembered that every medicine should be prescribed to the patient by his attending physician on an individual basis. The specialist will also help calculate the optimal dosage of drugs for the patient and the duration of the therapeutic course.

In case of exacerbation of the disease or in the absence of proper results of drug therapy, the patient is hospitalized. Further treatment includes a course of antibiotic therapy, gastric lavage, intestinal cleansing using siphon enemas, droppers with colloidal solutions.

Diet food

Treatment of colon diverticulosis necessarily includes diet therapy. The basis of the patient's diet should be food rich in plant fiber. IN daily menu The following products must be included:

• wheat and buckwheat cereals;
• bran;
• vegetable oil;
• vegetable soups;
• beef or chicken broth;
• dairy products;
• bran bread;
• baked vegetables and fruits;
• fruit and vegetable juices.

It is very important that the patient maintains proper drinking regimen, consuming about 2.5 liters of liquid throughout the day.

But patients suffering from intestinal diverticulosis will have to refrain from taking the following products:

• White bread;
• coffee;
• pasta;
• semolina;
• chocolate;
• sausage;
• jelly;
• fatty meats and fish.

Folk recipes

Treatment folk remedies diverticulosis can be effective only in the composition complex therapy, subject to diet and taking medications prescribed by the doctor.

The following simple recipes from the arsenal of ancient medicine will help to alleviate the patient’s condition and speed up the recovery process:

1. Apple-wheat mixture - excellent natural remedy to cleanse the intestines. To prepare the medicine, you need to combine sprouted wheat grains and grated green apples in identical proportions. It is recommended to take the drug on an empty stomach for a month.
2. Healing infusion. In order to prepare such an infusion, you need to take equal quantities of dried dill, rose hips, nettle, and chamomile. 1 tbsp. l. The herbal mixture should be poured with 1 glass of boiling water and allowed to brew for about 3 hours. It is recommended to drink the decoction 2 times a day before meals. The optimal duration of the therapeutic course is 1.5 months.
3. Mint infusion - has a beneficial effect on the condition of the gastrointestinal tract, helps eliminate flatulence and pain. 1 tsp. mint (the herb can be used either fresh or dry) you need to pour 1 glass of boiling water, leave for a little and drink this tasty, aromatic, healing drink instead of the usual tea.
4. Sloe infusion perfectly cleanses the intestines and normalizes its functioning. To prepare a medicinal drink, you need to pour 3 tbsp. l. blackthorn 1 liter of boiling water and let it brew thoroughly. It is recommended to drink the resulting infusion 1 glass before meals, 4 times throughout the day. The duration of the therapeutic course is 5 days.

Surgical methods

Surgical removal of a diverticulum may be recommended to the patient in the following cases:

• intestinal obstruction;
• internal bleeding;
• abscesses;
• formation of intestinal fistulas;
• lack of effectiveness of conservative therapy.

During the operation, the affected area of ​​the intestine is excised, and the remaining parts are carefully stitched together.

How to avoid getting sick? Since it is quite difficult to fight diverticulosis, doctors advise patients to adhere to the following preventive recommendations:

1. Eat rationally.
2. Do gymnastics aimed at strengthening muscle fibers in the abdominal area. News active image life.
3. Drink at least 2 liters of liquid throughout the day.
4. Treat constipation and infectious intestinal diseases in a timely manner.

At least once every 2 years, it is necessary to undergo an intestinal examination for preventive purposes.

Intestinal diverticulosis - serious pathology, complications of which pose a threat not only to the health, but also to the life of the patient. Diverticular disease is quite difficult to treat, so it is very important to monitor your diet and lead an active lifestyle to reduce the likelihood of its occurrence. The fight against intestinal diverticulosis must be comprehensive and certainly include a therapeutic diet. Only in this case can you count on quick favorable results of the therapeutic course.