Diverticulosis of the sigmoid colon
The content of the article:
- Causes and risk factors
- Disease form
- Symptoms of sigmoid diverticulosis
- Diagnostics
- Treatment of sigmoid diverticulosis
- Potential consequences and complications
- Forecast
- Prevention
Diverticulosis of the sigmoid colon is a disease accompanied by the formation of small saccular protrusions on the intestinal wall, called diverticula. Diverticulosis of the sigmoid colon is a widespread pathology that is diagnosed in about 10% of the adult population of developed countries. In this case, clinical signs of the disease occur only in every fifth patient. In all the rest, the disease is asymptomatic, and it is detected accidentally, during examination for another reason, or it is not detected at all during the patient's life.
The problem of diverticulosis of the sigmoid colon is most relevant for residents of economically developed countries, whose diet contains few foods containing coarse dietary fiber.
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Causes and risk factors
The following reasons lead to the formation of sigmoid diverticula:
- disturbances of intestinal peristalsis;
- dystrophic processes in the intestinal wall;
- vascular pathology.
Most often, not one factor is involved in the pathological mechanism of the development of this disease, but their combination.
Dystrophic processes in the submucosa, mucous membrane and muscular layers of the intestine occur in elderly people, or in patients suffering from congenital anomalies in the structure of connective tissue, impaired collagen synthesis.
In young and middle-aged people, altered peristalsis usually leads to the development of sigmoid diverticulosis. The muscle fibers of the intestinal wall cease to contract in a harmonious and coordinated manner, as a result of which the passage of intestinal contents is disrupted, and intraintestinal pressure rises. This provokes the separation of muscle fibers with the formation of saccular protrusions.
Vascular disorders are of great importance in the pathological mechanism of development of sigmoid diverticulosis. Stagnation of blood in the microvasculature causes a disturbance in metabolic processes in the intestinal wall, which further enhances dystrophic changes and creates the preconditions for the formation of diverticula.
The features of the anatomical structure of the sigmoid colon also predispose to the formation of diverticula. Its muscle layer is located along the intestinal wall in the form of three ribbons. In the gap between them are blood vessels. It is these gaps that are most susceptible to increased intra-intestinal pressure.
Disease form
According to the features of the morphological structure, the diverticula of the sigmoid colon are divided into two types:
- false - only the mucous membrane protrudes;
- true - all layers of the intestinal wall take part in the formation of protrusion.
Depending on the characteristics of the clinical picture, diverticulosis of the sigmoid colon is distinguished:
- asymptomatic course;
- uncomplicated course with a pronounced clinical picture;
- complicated (peritonitis, intestinal perforation, intestinal bleeding, intestinal abscess, diverticulitis).
Symptoms of sigmoid diverticulosis
In most cases, the disease is asymptomatic. Patients do not assume the presence of this pathology until complications appear or before the examination of the large intestine associated with some other, usually proctological, disease.
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In 20% of patients, recurrent cramping pains, similar to those accompanying intestinal colic, become a symptom of sigmoid diverticulosis. They can be spilled or localized in the left iliac region. After passing gas and / or stool, the pain subsides.
Also, symptoms of sigmoid diverticulosis can be:
- stool instability (constipation alternating with diarrhea);
- flatulence;
- recurrent nausea.
Diagnostics
If sigmoid diverticulosis is suspected, the patient is referred for an irrigoscopy. This is an X-ray method for examining the large intestine using a contrast agent (barium suspension). Irrigoscopy allows you to assess the size of diverticula, their number, as well as the diameter of the lumen of the sigmoid colon, the features of the peristalsis of its walls. For a better identification of all available features, the study is recommended to be performed in several projections.
If necessary, a colonoscopy is performed - an endoscopic examination of the large intestine. During the procedure, the condition of the intestinal mucosa and diverticula is assessed, and foci of bleeding and / or inflammation are identified. If a malignant process is suspected, a biopsy is performed, followed by a histological examination of the resulting biopsy.
Laboratory diagnostic methods for sigmoid colon diverticulosis are of an auxiliary nature. They are mainly needed to identify possible complications.
With inflammation of diverticula, that is, the development of diverticulitis in the general blood test, leukocytosis, a shift in the leukocyte formula to the left, an increase in ESR are noted.
Latent intestinal bleeding is diagnosed by an occult blood test. Long-term intestinal bleeding leads to a decrease in the level of hemoglobin and the number of red blood cells in the blood.
Diverticulosis of the sigmoid colon must be differentiated from the following diseases:
- sigmoid colon cancer;
- Crohn's disease;
- ischemic colitis;
- irritable bowel syndrome;
- nonspecific ulcerative colitis.
Treatment of sigmoid diverticulosis
Properly organized therapeutic nutrition is of no small importance in the complex therapy of the disease. In uncomplicated sigmoid diverticulosis, the diet should include a large number of foods rich in fiber. If proper nutrition does not lead to the normalization of the stool, then the patients are prescribed laxatives, bran.
In order to normalize peristalsis, prokinetics and antispasmodics are prescribed. If indicated, enzyme preparations can be used.
With the development of diverticulitis, antibacterial and detoxification therapy is performed.
In case of intestinal bleeding, drugs that improve blood clotting are used.
Routine surgical treatment of sigmoid diverticulosis is indicated for multiple protrusions. Indications for emergency surgery are peritonitis, formation of abscesses, fistulas, perforation of the diverticulum. The essence of the surgical intervention consists in excision of the affected area of the sigmoid colon.
Potential consequences and complications
When complications appear, the symptomatology of sigmoid diverticulosis becomes brighter.
Diverticulitis is most commonly seen. It is caused by stagnation of feces in the sigmoid colon and directly in the lumen of the diverticulum. With diverticulitis, abdominal pain increases, body temperature rises, and signs of general intoxication of the body appear (headache and muscle pain, weakness, loss of appetite). On palpation of the anterior abdominal wall, a slight muscle tension of the left iliac region is determined. Further spread of the inflammatory process to the surrounding soft tissues leads to the formation of an inflammatory infiltrate. On palpation of the abdomen, it is defined as a painful lump located in the left half of the abdominal cavity and has limited mobility. If untreated, the infiltrate transforms into an abscess. The patient's condition deteriorates sharply. The temperature rises rapidly to febrile values, which is accompanied by tremendous chills. Fever takes on a hectic nature, which is characterized by significant temperature fluctuations during the day. Palpation of the abdomen is sharply painful. Symptoms of local irritation of the peritoneum are revealed.
A severe complication of sigmoid diverticulosis is perforation or perforation of the diverticulum. It can develop both against the background of diverticulitis, and in the absence of an inflammatory process. In patients, the body temperature rises, and abdominal pain appears and rapidly increases. The outcome of perforation of the diverticulum is either retroperitoneal phlegmon or peritonitis. The development of these complications of sigmoid diverticulosis leads to the formation of a symptom complex of an acute abdomen.
Perforation of a diverticulum can occur in a hollow organ (bladder, small intestine, vagina) or on the surface of the skin, resulting in a fistula.
Injury of the walls of the diverticula of the sigmoid colon with dense feces is accompanied by the occurrence of intestinal bleeding. Its symptom is the appearance of small streaks of scarlet blood on the surface of the feces. Bleeding with diverculosis of the sigmoid colon extremely rarely takes on a profuse character, but also tends to frequent relapses, as a result of which iron deficiency anemia gradually develops.
Forecast
The outlook is generally favorable. In 80% of patients, the disease is asymptomatic throughout life. The prognosis worsens slightly with age, as well as with the development of complications (diverticulum perforation, abscess, peritonitis).
Prevention
The main importance in the prevention of the occurrence of sigmoid diverticulosis is given to proper nutrition. The diet should include a sufficient amount of foods rich in fiber (boiled and fresh vegetables, fruits, buckwheat, pearl barley, oatmeal, lentils, dried apricots, dates, raisins). It is known that in countries whose traditional cuisine is represented mainly by cereals and vegetables, diverticulosis of the sigmoid colon is practically not found.
To normalize intestinal motility and prevent constipation, it is necessary to adhere to the water regime and regular physical activity (sports, exercise therapy, long walks in the fresh air).
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
