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Diverticulosis of the intestine
Last reviewed: 23.04.2024
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Diverticulosis is a disease characterized by multiple diverticula in the large intestine, probably due to prolonged eating of low fiber foods. Most diverticula are asymptomatic, but some are complicated by inflammation or bleeding. The diagnosis is made with an irrigoscopy or a colonoscopy. Treatment of diverticulosis of the intestine depends on the symptoms.
Diverticulum of the intestine - saccular protrusion of the intestinal wall, communicating with its lumen. Diverticula are single and multiple, in the latter case the term "diverticulosis" is used.
What is the diverticulum of the intestine and diverticulosis?
Diverticula are saccular protrusions of the mucous membrane that swell out of the intestinal wall. True diverticula contain all layers of the basic structure. False or pseudodiverticles are protrusion of the mucosa through the muscle layer. Esophageal diverticula or diverticulum of Meckel are the true diverticula. Colon diverticula - pseudodiverticles; they are manifested by symptoms with stool in them, infection and inflammation, bleeding or perforation.
Meckel's diverticulum is a congenital protrusion in the terminal ileum, the remainder of the embryonic yolk-intestinal duct.
Diverticular disease (diverticulosis) is a disease characterized by clinical manifestations due to the presence of diverticulosis, including inflammation (diverticulitis) and its complications (peridiverticulitis, abscess, diverticulum perforation, fistula, peritonitis), and bleeding.
ICD-10 code
- K57 Diverticular Bowel Disease
- K57.2 Diverticular disease of large intestine with perforation and abscess
- K57.3 Diverticular disease of large intestine without perforation and abscess
- K57.4 Diverticular disease of the colon and small intestine with perforation and abscess
- K57.5 Diverticular disease of the colon and small intestine without perforation of the abscess.
Epidemiology
Epidemiology of intestinal diverticulosis
Diverticulum of the large intestine is found only in 5% of persons under 50, in 30% of people over 50 and in 50% of people over 70 years old. The most common localization of diverticula is the left half of the large intestine (with the exception of the rectum). Meckel's diverticulum is found in 2% of people, 5% of whom develop bleeding.
Diverticula can develop in any part of the colon, but more often in sigmoid, rarely below the peritoneal bend of the rectum. They vary in diameter from 3 mm to more than 3 cm. Usually both patients are found in both. Diverticulosis is not characteristic for people under 40 years of age, but it becomes common in older people; in fact, every person for 90 years found a lot of diverticula. Giant diverticula in diameter from 3 to 15 cm are rare and can be single.
In 70% of cases diverticula are located in the sigmoid part of the colon, due to its anatomical and functional features: smaller diameter, more bends, more dense consistency of contents. In addition, the sigmoid colon has a reservoir function, so the intraluminal pressure in it is higher.
Diverticula of the small intestine develop less often. The most frequent localization is the duodenum, mainly its distal part. In 3% of cases, the diverticula of the duodenum are combined with the diverticula of the lean and subvascular gut.
Causes of the diverticulosis of the intestine
What causes diverticulosis of the intestine?
The formation of diverticula is most likely caused by increased pressure in the gut lumen, leading to extrusion of the mucosa through the weakest areas of the muscular gut layer, the zones adjacent to the intramural blood vessels. Diverticulum of the intestine is more typical for people who eat low-fiber foods; but the mechanism of this is unclear. One theory is that increased pressure in the luminal gut should move a small volume of stool through the colon; according to another theory, a small volume of stool forms a large diameter small intestine, which, according to Laplace's law, should cause an increase in pressure.
The etiology of giant diverticula is unclear: according to one theory, the diverticulum is based on a disruption similar to a valve in which a gas, liquid and dense intestine contents enter it easily, but come out with difficulty.
Symptoms of the diverticulosis of the intestine
Symptoms of diverticulosis of the intestine
The majority (70%) of diverticula is asymptomatic, in 15% of cases they are complicated by severe inflammation (diverticulitis) and painless bleeding develops in 10-15%. Bleeding, most likely, is caused by the erosion of a nearby vessel at a local injury with dense feces caught in the diverticulum. Although most diverticula are distal, in 75% of cases the source of bleeding is located in the diverticula, proximal to the splenic corner. In 1/3 of patients (a total of 5% of all gastrointestinal bleeding ), bleeding is severe enough that requires transfusion.
Diagnostics of the diverticulosis of the intestine
Diagnosis of intestinal diverticulosis
Asymptomatic leaking diverticula usually come to light accidentally with an irrigoscopy or a colonoscopy. Diverticulosis of the intestine should be suspected in the development of painless rectal bleeding, especially in elderly patients. Diagnosis of rectal hemorrhage usually involves a colonoscopy, which can be performed following the indication after usual preparation, if there is no significant ongoing bleeding.
In such patients, rapid preparation (5-10 L of a solution of polyethylene glycol injected through a nasogastric tube for 3-4 hours) often allows for adequate visualization. If at the colonoscopy the source of bleeding is not detected and the intensive bleeding continues (more than 0.5-1 ml / minute), the source can be detected by angiography. Some angiorentgenologists first perform a radionuclide study to accurately localize the source.
[8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20]
Screening of diverticulum of the intestine
There are no screening events.
What do need to examine?
What tests are needed?
Who to contact?
Treatment of the diverticulosis of the intestine
Treatment of diverticulosis of the intestine
Treatment of diverticulosis of the intestine is aimed at reducing segmental spasm. Can be an effective diet with a high fiber content with the addition of drugs of psyllium seeds or bran. A diet low in fiber is contraindicated. The intuitive exclusion of the use of seeds or other dietary material that could linger in the diverticulum, has no confirmed medical justification. Antispastic drugs (eg, belladonna) are not effective and can cause adverse effects. Surgical treatment of diverticulosis of the intestine is not indicated in the absence of complications. Giant diverticula, however, require surgical treatment.
Diverticular bleeding stops spontaneously in 75% of patients. Treatment of diverticulosis of the intestine is often carried out simultaneously with the diagnosis. If angiography was performed to diagnose, continued bleeding can be stopped in 70-90% of patients by intra-arterial injection of vasopressin. In some cases, bleeding recurs within a few days and requires surgical treatment. Angiographic embolization effectively stops bleeding, but can lead to intestinal infarction in 20% of patients and is not recommended. Colonoscopy allows you to perform thermo- or laser vascular coagulation or enter adrenaline. If these measures fail to stop bleeding, segmental resection or subtotal colectomy is indicated.
Prevention
How to prevent diverticulosis of the intestine?
Diverticulosis of the intestine can be prevented if the prevention of constipation : adequate dietary fiber, exercise therapy, massage.
Forecast
What prognosis does the intestinal diverticulosis have?
Diverticulosis of the intestine in most cases has a favorable prognosis, but in some situations it can lead to the development of severe and life-threatening complications. This can be explained not only by the severity of the complications themselves, but also by the primary lesion of the elderly, who often already have concomitant diseases.
Acute diverticulitis occurs in 10-25% of patients with diverticular disease. The probability of success of conservative therapy of acute diverticulitis is 70% at the first episode and only 6% - with the third episode.
On average, 20-30% of patients with diverticular disease complicated by hemorrhage experience repeated bleeding in a few months or years. Preventive symptomatic treatment of uncomplicated disease with increasing intake of dietary fiber in a number of cases (5-10%) reduces the incidence of complications and improves the course of the disease.