Diverticulitis of the intestine - Causes, symptoms and treatment. MF.

Some people may find a diverticulum in the esophagus or in the wall of the colon when examining a gastrointestinal disease. Also, the doctor in conversation with the patient can use the concepts of diverticulosis and diverticulitis. In order to clarify the features of these forms, it is necessary to determine the terminology.

The diverticulum of is the protrusion of the wall of a hollow organ that has a sacciform character and is localized in the esophagus, stomach, in the small or large intestine.

Diverticulosis is a nosological form that unifies the process of formation of diverticula, or, in other words, a disease characterized by the appearance of diverticula. Multiple diverticula are more common in the large intestine, while in the esophagus and in the stomach single protrusions are formed. In most cases, diverticulosis is not clinically manifested in the early stages or manifests itself with minor symptoms.

Diverticulitis is an inflammatory process that covers the wall of the diverticulum and the adjacent part of the intestine, which manifests itself as severe symptoms and can lead to the development of complications.

If the diverticulum and uncomplicated diverticulosis do not usually cause a discomfort to the patient, diverticulitis due to pronounced changes in the intestinal wall requires timely treatment, and in some cases may lead to the need for surgical intervention.

Due to the fact that the intestine has anatomical and physiological characteristics other than the esophagus and stomach, diverticulitis is more common in the large intestine.

Causes of intestinal diverticulitis.

Inflammatory process in the wall of the diverticulum is due to stagnation of food particles and fecal matter in the lumen of protrusion. Due to the fact that the diverticulum has a thin neck and a wider cavity, the stools in the cavity do not go back into the lumen of the gut, but exert pressure on the diverticulum wall, which gradually becomes thinner with a violation of the circulation. These processes are prerequisites for inflammation in the wall of the diverticulum. In addition, in the lumen of the intestine, there are many diverse microorganisms that, if the diet is violated and the slightest decrease in immunity, can cause inflammation.

Diverticula of the colon - saccular protrusion of the intestinal wall.

The following factors can predispose to the development of diverticulitis:

- constipation leading to disruption of the intestinal contents passage and stagnation of fecal masses in the lumen of the gut and in the cavity of the diverticulum,
- diet disorders - reduced fiber intake facilitating fecal matter movement,food that is difficult to digest in the digestive tract, as well as excessive intake of animal protein( meat, eggs), contributing to the development of putrefactive processes in the intestine,
- intestinal andinfections and helminthiases that cause inflammation of the intestinal wall,
- elderly age - due to decreased intestinal motility in elderly patients, constipation and inflammation of diverticulum occur more often.

Symptoms of intestinal diverticulitis.

The diverticula itself does not cause symptoms in most cases. But if the diverticulitis develops, the clinical picture becomes more pronounced. The patient notes such symptoms as:

- Acute abdominal pain that assumes a constant pulling character that is not stopped by antispasmodics and pain medications or ceases for a short time after they are taken. Such pain is localized more often on the left side and is enhanced by coughing, laughing and defecation in connection with increased intra-abdominal pressure. Often such pain can be regarded by the patient as a sign of kidney or gynecological disease. When the anterior abdominal wall is probed, the pain is determined in one area, that is, it is not spilled, and is strengthened when pressed.
- Nausea, vomiting, bloating, loose stools or constipation are signs of digestion and intoxication due to an inflammatory process that seizes not only the diverticulum but also the nearby wall of the bowel.
- Increased temperature, lethargy, weakness, fatigue also indicate an inflammatory process.
- Blood stasis in feces or black stools may occur with bleeding from vessels located in the area of ​​the inflamed diverticulum.

A patient who has an established diagnosis of a diverticulum should remember that in case of sudden appearance of such symptoms, and first of all, severe abdominal pain, it is necessary to see a doctor as soon as possible in order to start treatment in time and avoid dangerous complications.

Diagnosis of diverticulitis.

The diagnosis of diverticulitis can be assumed even during the examination of the patient, especially if there is an indication in the anamnesis of confirmed intestinal diverticula. With palpation of the abdomen( probing), the doctor can determine the local or diffuse( with peritonitis) soreness, the tension of the abdominal muscles and the compressed inflamed part of the intestine. To clarify the diagnosis, it is necessary to conduct a series of studies designated by a doctor as a gastroenterologist or surgeon:

- The ultrasound of the abdominal and intestinal organs can reveal a rounded formation filled with fluid or dense substance with a changed echostructure, as well as a thickened bowel wall in the area of ​​inflammation of the diverticulum,
- irrigography -X-ray examination of the intestine with the help of a radiopaque substance administered through the mouth or with the help of an enema allows one to determine the "flow" of contrast into the diverticulum,and also to detect a rupture or fistula of a diverticulum, in this case the contrast will be outside the intestine in the abdominal cavity,
- colonoscopy - examination of the colon with the help of endoscopic equipment inserted through the anal opening - the most reliable way to detect a diverticula that allows to examine the intestinal wall from the inside and to revealsigns of inflammation or bleeding,
- laparoscopy - examination of the abdominal cavity from the inside with the help of endoscopic equipment inserted through the holes in the anterior abdominal wall - nIt allows one to consider the outer surface of the colon thoroughly, detect diverticula, and in case of reading to their removal to perform laparoscopic surgery immediately.

Treatment of intestinal diverticulitis.

The first few episodes of diverticulitis may well be treated conservatively with the use of medications, if there is a low risk of complications, and the inflammation easily lends itself to drug therapy. The following groups of drugs are prescribed from medicines:

- Antibiotics are mandatory in the treatment of inflammation, as they allow to eliminate the source of infection in the cavity of the diverticulum. More often, broad-spectrum drugs are prescribed, such as cefotaxime, metronidazole, ciprofloxacin, doxycycline, etc. At the beginning of the treatment, the drugs are administered intramuscularly or intravenously, and then switched to tablet form. Antibiotic therapy is conducted for at least 2 weeks, sometimes longer according to the indications.
- Spasmolytics that help to eliminate bowel spasm and relieve the tension of the inflamed area - no-spa, platifillin, papaverine, etc.
- Laxatives should be administered with caution and only under the supervision of the doctor, since a strong increase in intra-abdominal pressure with frequent acts of defecation can leadto the rupture of the wall of the diverticulum. At the same time, the purpose of these drugs is justified, since permanent constipation also leads to increased pressure in the abdominal cavity. Lactulose-based drugs - norma, dyufalac, etc. are prescribed.

In case the patient suffers from frequent exacerbations of diverticulitis, and there is a high risk of complications or they have already developed, surgical intervention is performed, which can be carried out in planned or urgent order.

Indications for operation:

- intestinal bleeding from diverticulum vessels,
- rupture or fistula of diverticulum,
- interintestinal abscess( accumulation of pus between loops of bowel),
- intestinal obstruction,
- peritonitis - diffuse inflammation in abdominal cavity,
- frequentand recurrent exacerbations of diverticulitis.

Contraindications for operation:

- there is no contraindication for operation for emergency indications, as in case of a life-threatening condition with diverticulitis, the operation is the only way to save the patient's life,
- the planned operation can be delayed or transferred because of the patient's exacerbation of internal diseasesorgans, acute infectious disease and fever, severe general condition due to acute heart disease, lungs, kidneys and so on.

The procedure of the operation is as follows - access to the abdominal organs under general anesthesia is performed, the inflamed area of ​​the intestine is cut with colostomy for the removal of fecal matter by means of an opening in the anterior abdominal wall, which after several weeks is removed and the dissected sections of the intestine are reattached. Such operations are carried out in two or three stages with an interval of several weeks.

In the case of small sores of an inflamed diverticulum without complications, laparoscopic surgery is performed in one step.

Lifestyle.

To prevent diverticulitis with existing intestinal diverticula, the following principles should be observed:

- the foundations of a healthy lifestyle - adequate exercise, avoiding bad habits, hardening, walking outdoors, etc.,
- a rational food for normalizing digestion, eliminating constipation withlight diet - the exclusion of fatty and fried foods, compliance with the water regime with a daily intake of at least 2 liters of water, enriching the diet with products containing vegetable oils and bA large amount of fiber( vegetables and fruits, cereals, bran),
- maintenance of immunity - prolonged exposure to fresh air, contrast showers, intake of vitamins by courses,
- taking probiotics containing lacto- and bifidobacteria after each course of antibiotics for at least two weeks formaintenance of normal microflora in the intestinal cavity.

Lifestyle after surgery is reduced to the same principles as described above. Additionally, one can note the avoidance of excessive physical exertion and lifting of weights in the first few weeks after the operation. In addition, the withdrawn colostomy can cause serious psychological discomfort to the patient. In order to feel confident, he must remember that this is a temporary inconvenience, which is eliminated after a few weeks, and psychological mood is very important for complete recovery.

Complications of intestinal diverticulitis.

Without surgery, bleeding, suppuration and rupture of diverticulum with development of peritonitis, fistula formation, intestinal obstruction and malignant degeneration of the diverticulum are possible. Prevention of complications is the timely access to a doctor and the correct treatment that is observed by the patient.

Postoperative complications include suppuration and divergence of sutures, inflammation of the postoperative wound, severe dysfunction of the cardiac and bronchopulmonary system. Similar complications develop no more often than with any other abdominal surgery.

Forecast.

The prognosis for competent treatment and absence of complications is favorable. In the case of a complicated course of diverticulitis, the prognosis for health is questionable and is determined by the degree of abnormality of the body, for example, the severity of anemia after bleeding, the activity of the inflammatory process in case of abscess of the intestine or peritonitis, etc.

In conclusion, it should be noted that timely access to a doctor in casethe appearance of complaints allows early detection of the disease, and the timely treatment of diverticulitis can protect the patient from the need for surgical intervention.

Doctor therapist Sazykina O.Yu.