Colonic diverticula - Diagnosis

Recognizing diverticular disease is not an easy task. This is explained by the absence of pathognomonic symptoms, the possibility of different localization of diverticula, and therefore pain, the main clinical sign of this disease, the presence, as a rule, in elderly people of concomitant diseases, the symptoms of which can mask the manifestations of diverticular disease. At the same time, early diagnosis of diverticular disease is extremely important due to the high potential risk of developing complications, often life-threatening. It is possible to assume the diverticular nature of peritonitis, intestinal bleeding and other complications based on clinical manifestations only when it is already known that the patient has diverticula in the colon.

The leading method in diagnosing diverticular disease of the colon is X-ray, with irrigoscopy being preferable, since it is impossible to judge the number of diverticula even approximately when the colon is filled orally with a barium sulfate suspension. Hypersecretion, retention of contents in diverticula, aggravated by spasm and cervical edema, may prevent their detection. Therefore, careful preparation of the patient for the examination is important.

Diverticula are detected as additional cavities of a round, finger-like shape, connected by an isthmus to the lumen of the intestine. Most often they are located along the outer and inner contour, less often - along the entire circumference of the intestine. Diverticula are better defined after emptying the intestine from the main mass of the contrast agent introduced in the enema, when they contain its remnants in the form of plaque and are clearly visible against the background of the relief of the mucous membrane. Diverticula are especially clearly visible with double contrasting, since they expand when air is introduced, and the barium sulfate suspension retained in them emphasizes their contours. With tight filling, fewer diverticula are detected, because they are overlapped by the intestine filled with this suspension.

In diverticular disease of the colon, irrigoscopy may reveal pronounced disturbances in motor function: spasms, hypermotility of the intestinal sections containing diverticula, deformation of the haustra, and uneven emptying. These signs are equally often observed in diverticulosis and diverticulitis.

A barium enema should be administered only after the inflammation has subsided due to the risk of perforation (not earlier than 7-14 days after the start of therapy) and double contrast is not recommended in such situations.

Incomplete diverticula are occasionally recognized as small depots of contrast agent (in the form of spots) inside the intestinal wall, connected by thin dash-like channels with the intestinal lumen or in the form of similar channels, creating an accordion-like contour of it. However, this radiographic sign is non-specific. It can occur with non-filling of complete diverticula, hypertrophy of the intestinal muscle in conditions of diverticulosis and its absence.

In each case of detection of diverticula it is necessary to decide on the presence of an inflammatory process in them. The only reliable radiographic sign of diverticulitis is a long - 2 days or more - retention of barium sulfate suspension in the diverticulum cavity. In this case, it is necessary to exclude the presence of stones in the urinary and biliary tract, calcification of the pancreas, the presence of phleboliths in the abdominal cavity and small pelvis. Other described radiographic signs of diverticulitis - uneven contours of the diverticulum, display of only the bottom or only the neck, fluid with a horizontal level in the diverticulum cavity - are unreliable. The first two are often noted in diverticulosis, the last - rarely in diverticulitis. In the diagnosis of diverticula of the colon, radiographic examination is important, in the detection of diverticulitis - a general clinical examination of the patient.

Colonoscopy also allows detecting diverticula, diagnosing (in some cases) diverticulitis, and assessing the condition of the colon mucosa. However, this examination is contraindicated for elderly and senile patients.

Colonoscopy reveals the mouths of diverticula of a round or oval shape, sometimes closing and becoming slit-like. The cavity of the diverticula often cannot be examined along its entire length, since it is usually larger than the size of the entrance to the diverticulum. Diverticula are often filled with contents, and at times its entry into the intestinal lumen can be observed. Endoscopic signs of diverticulitis include deformation of the mouth of the diverticulum.

Colonoscopy can be of great help in diagnosing the source of intestinal bleeding. This method is of particular importance in the differential diagnosis of inflammatory infiltrate and carcinoma, in distinguishing diverticular disease from ulcerative colitis, Crohn's disease, ischemic colitis and other colon pathologies.

Laboratory tests allow to recognize diverticulitis. First of all, it is an increase in ESR, hyperleukocytosis. Coprological data confirm the presence of inflammation - detection of neutrophils in feces, admixture of a large number of mononuclear cells in mucus, desquamated epithelium - less often.

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