Colon Diverticula - Prevention

To prevent and treat diverticulitis, it is necessary to normalize the intestinal microflora. For this purpose, it is necessary not only to act on certain opportunistic microorganisms, but also to increase the reactivity of the macroorganism. Patients are prescribed vitamins, desensitizing agents, eubiotics, biological preparations (bifidumbacterin, lactobacterin, bificol for 1.5-2 months).

In case of exacerbation of chronic diverticulitis, bed rest is recommended. The patient should be hospitalized to avoid complications. In severe cases, parenteral nutrition, detoxification therapy with compensation of fluid, electrolytes, and vitamins are indicated for the first 1-3 days; for the next 5-10 days, semi-liquid, easily digestible food with reduced caloric content (such as table No. 4) is recommended for maximum mechanical and chemical sparing of the intestine. Then the diet is gradually expanded. From the very first hours, in addition to antispasmodic and anticholinergic agents, broad-spectrum antibiotics are given for 10-14 days (ampicillin, tetracycline, gentamicin, ciprofloxacin, etc.). Hard-to-absorb antibiotics and sulfonamides are ineffective, since the treatment involves eliminating the infection localized not only in the intestinal lumen, but also in the tissues. Studies of stool and blood flora in the acute phase of the disease initially cannot help in choosing antibiotics, but later they make it possible to correct therapy.

Subsequently, according to indications (if signs of inflammation persist), a course of treatment is carried out with other agents with antibacterial action - metronidazole, nitrofuran drugs, nicodine, intetrix. The latter is an intestinal antiseptic with a wide range of anti-infective activity, including intestinal antifungal, effective for diarrhea.

In case of persistent constipation with exacerbation of chronic diverticulitis, contact laxatives are used - guttalax, bisacodyl or normase, which increases the volume of intestinal contents due to direct and osmotic action (due to its metabolization by bacteria of the large intestine with the formation of low-molecular acids). Acidification of the contents of the large intestine helps to normalize the intestinal microflora. Vaseline oil can be prescribed for a short period. Enemas are contraindicated during this period due to the risk of perforation of diverticula.

In most patients, conservative treatment gives certain results during exacerbation of chronic diverticulitis. However, if the above complications develop, surgical treatment is required. Choosing the right moment for surgical intervention is a difficult and critical decision in clinical gastroenterology.

The method of "embolization" of vessels is used to stop bleeding from the distal parts of the digestive tract, in particular in case of bleeding from diverticula of the colon, since the colon has a relatively limited collateral blood supply, and surgical treatment of such bleeding is quite complex.

As the exacerbation of the inflammatory process subsides (stage II of treatment for exacerbation of chronic diverticulitis), agents with local astringent, enveloping, adsorbing action, and eubiotics are prescribed. At stage III (after 3-4 weeks), microclysters with a solution of collargol, antipyrine, and chamomile (for 10-14 days) are prescribed.

In chronic diverticulitis without exacerbation, antibacterial drugs are not recommended. Treatment begins immediately with stage II. In case of a sluggish inflammatory process, it is advisable to conduct a 7-10-day course of anti-inflammatory treatment.

In case of diverticular disease of the colon, patients are subject to outpatient observation.

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