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Diverticulum of the large intestine
Last reviewed: 23.04.2024
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Diverticulum is a herniated formation in the wall of the hollow organ. By this term, for the first time in 1698, Ruysch designated a saccular protrusion in the ileal wall of the intestine. The first work on diverticula of the large intestine in humans was published by Morgagni in 1769, and the clinical picture of diverticulitis was described by Virchow in 1853.
Diverticular disease of the colon is a collective concept, including both uncomplicated and complicated diverticula (according to some authors, diverticula with symptoms). Diverticulosis of the colon is the presence of multiple diverticula (a number of researchers understand this term only uncomplicated diverticula).
Frequency and epidemiology. Diverticulum of the large intestine is a common pathology. Their frequency increases with age. They occur in the general population in 3-5% of cases, in individuals over 40 years - in 10%, over 60 in 30%, over 70 in 40%, in persons 85 and older - in 60-66% of cases . In industrially developed countries, diverticulosis is detected much more often than in developing ones, in rural areas is less frequent than in cities, which is associated with the peculiarities of nutrition. Racial characteristics are not decisive, since the indigenous inhabitants of Asia and Africa, when moving to the West and changing their traditional diet to low-slice food, suffer this pathology as often as Westerners.
Most authors believe that diverticular disease of the colon is equally common in men and women. However, there is evidence of a slight predominance of men, and of a higher incidence of disease in women.
At present, there is no consensus on the existence of a dependence of the incidence of diverticular disease of the colon on the degree of fatness and the nature of work activity.
Classification of diverticula. Divergent divisions are true and false. True represent the swelling of the entire intestinal wall, which contains the mucous membrane, the muscle layer and serosa. They have a wide communication with the gut and are easily emptied. Usually these are single diverticula, rarely multiple. Inflammation in them develops relatively rarely, just as not all people have appendicitis.
Classification of diverticulum of the large intestine
Causes of development and pathogenesis of diverticular disease of the colon. Intestinal diverticula can be congenital and acquired. Congenital diseases arise from a local developmental defect. The causes and mechanism of development of acquired diverticula remain unexplained. It is believed that 2 groups of factors are responsible for their occurrence: factors that increase intestinal pressure (constipation, flatulence, the systematic use of laxatives, intestinal stenosis, etc.) and induce intestinal wall weakness (beriberi, degeneration, inflammation, ischemia, stasis in the portal system veins, abdominal trauma, fatty degeneration of the intestinal muscle, congenital insufficiency of the intestinal wall).
Causes of developing diverticulum of the colon
On the basis of clinical features, asymptomatic diverticula, uncomplicated diverticular disease and diverticular disease with complications are distinguished.
For a long time, there was a perception that the uncomplicated diverticular disease of the large intestine was asymptomatic. The work of recent decades indicates the presence in most patients with uncomplicated diverticula clinical manifestations. Diverticula were asymptomatic in only 14% of cases of uncomplicated diverticulosis and in 5% of all cases of their detection.
Symptoms of diverticulum of the large intestine
Diagnosis of diverticular disease of the colon. Recognizing diverticular disease is not an easy task. This is due to the absence of pathognomonic symptoms, the possibility of different localization of diverticula, and therefore pain, the main clinical sign of this suffering, the presence, as a rule, in elderly persons of concomitant diseases, the symptoms of which can mask the manifestations of diverticular disease.
Diagnosis of diverticulum of the large intestine
Treatment of diverticular disease of the colon is conservative and surgical. Indications for surgical treatment are severe complications of the disease - massive, life-threatening bleeding, diverticulum perforation, peritonitis, abscess, fistulas, increasing intestinal obstruction and suspicion of cancer.
Treatment of diverticulum of the large intestine
For the prevention of diverticulitis and treatment it is necessary to normalize the intestinal microflora. For this purpose, it is necessary not only to influence certain conditionally pathogenic microorganisms, but also to increase the reactivity of the macroorganism. Patients prescribe vitamins, desensitizing agents, eubiotics, biological preparations (bifidumbacterin, lactobacterin, bifikol for 1.5-2 months).
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