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Diverticulum of small intestine
Last reviewed: 23.04.2024
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Diverticular disease is a fairly common disease in developed countries and is characterized by the formation of either separate or multiple diverticula in almost all parts of the digestive tract, as well as in the urinary and gallbladder. Therefore, some authors currently use the term "diverticular disease" rather than the previously used "diverticulosis" terms.
Diverticulum (from Latin divertere - to turn aside, to separate) - sack-like protrusion in the wall of a hollow organ. The term "diverticulum" Ruysch in 1698 first designated a herniated formation in the wall of the ileum. However, Fabricius Hildanus described such an education 100 years earlier.
Diverticulum and diverticular disease of the small intestine
According to the sectional data of various authors, the frequency of diverticula of all parts of the small intestine does not exceed 0.2-0.6%. Diverticula are much more common in the duodenum, mainly in the distal part of it. In 3% of cases, diverticula of the duodenum are combined with the diverticula of the jejunum and ileum.
A combination of the diverticulum of the duodenum with a tumor near it, a ganglion-cell paranglion, is described. Approximately in 1/3 of cases of diverticular disease of the colon, diverticula are found in the small intestine, more often in the duodenum, and sometimes also in the stomach and esophagus.
The small intestine consists of 3 sections and includes the duodenum, jejunum and ileum, which have their anatomical and functional features, and consequently, some clinical specificity of manifestation and course of a number of diseases, including diverticulum and diverticular disease. Therefore, it is advisable to focus on certain features of clinical anatomy, symptomatology and the course of this disease, depending on the localization of the pathological process.
Diverticulum of the duodenum is quite common. It is believed that the frequency of detection of individual diverticula (or divergikuleza) of the duodenum takes second place, second only to the diverticulosis of the large intestine. The frequency of duodenal diverticula, according to various authors, varies from 0.016 to 22% of cases.
Diverticula of the jejunum and ileum. Diverticula of the small intestine can be single and multiple, of different size and shape. The wall of congenital diverticula often does not have a muscular layer (congenital maldevelopment of the muscular shell of the intestinal wall), in contrast to the acquired (pulsion and traction) walls, whose wall has 3 layers: mucous, muscular and serous. As the size of the acquired diverticula increases, the muscular layer becomes thinner and the morphological differences between them and the innate are practically erased.
The etiology and pathogenesis of the duodenum basically do not differ from those of other localization in the digestive tract. However, one should take into account, firstly, that with diseases such as peptic ulcer, dyskinesia of the duodenum, cholelithiasis (especially with frequent attacks of biliary colic), and other diseases of the digestive system, especially with the combination of several of them, the frequency of diverticulum of the duodenum significantly increases.
Causes of development and pathogenesis of small intestine diverticula have not been fully elucidated. In some cases, they represent a congenital anomaly, developing in the weakest parts of the intestinal wall, in others - are acquired pathology. These are pulsion and tractional diverticula. Pulsatory diverticula arise with dyskinesia and spasms of the intestine, when areas of "relaxation" appear in adjacent areas with spasms, which leads to the swelling of the intestinal wall.
Causes of small intestine diverticula
Clinic of diverticulum of the duodenum. In most cases, diverticula of the duodenum are asymptomatic for a longer or less time or manifest as mild dyspeptic symptoms, mainly arising after disturbances in the usual rhythm and nature of nutrition. However, serious complications, most often occurring suddenly, are possible, after gross deviations from normal, generally accepted dietary norms, which manifest themselves with pronounced symptoms and often endanger the patient's life: diverticulitis, bleeding, perforation, etc.
Clinic of diverticulum of the jejunum and ileum. In most cases, the diverticula of the jejunum and ileum proceed asymptomatically and are detected by chance during an X-ray examination of the gastrointestinal tract or at autopsy. However, if the diverticulum has a narrow lumen connecting it to the bowel, and it is poorly emptied, it stagnates the chyme, sometimes small foreign bodies (chicken bones, fruit bones, etc.), possibly the development of diverticulitis and peridiverticulitis. This pain in the abdomen, symptoms of dyspepsia, in severe cases, the temperature rises, there are signs of general intoxication, increased ESR. There are catarrhal (most frequent), purulent (phlegmonous) and gangrenous forms of diverticulitis. Perforation is possible with gangrenous form due to wall necrosis. Sometimes intestinal diverticulum when a large vessel is damaged causes bleeding.
Symptoms of small intestine diverticula
Diagnosis of diverticulum of the duodenum is mainly based on the data of contrast X-ray examination (including indications and duodenography) and gastroduodenoscopy results. However, in this case, the endoscopist should be warned not only about examining the bulb of the duodenum (as is often the case, since in most cases, the main pathological processes, for example peptic ulcers, are most often localized in the bulb of the duodenum and in the stomach, besides endoscopic examination of the whole duodenal ulcer requires additional time, complicates, and in some cases complicates the study), but try to examine the entire duodenum.
Diagnosis of diverticulum of the jejunum and ileum. The main method for detecting diverticular disease of the small intestine is X-ray. To reveal the diverticulum of the ileum is very difficult and in the absence of complications, since it is poorly filled with contrasting mass. In addition, X-ray examination of the small intestine because of the peculiarities of its location is often difficult. If the diverticulum is filled with a suspension of barium sulphate, it has the appearance of a blind process that extends from the ileum.
Diagnosis of small intestine diverticula
Treatment of diverticulum of the duodenum in the absence of pronounced symptoms of the disease is limited to medical supervision of the patient (at first 1 to 3-6 months, then, with a "calm" course of the disease, strict compliance with patient medical recommendations and no signs of a significant increase in the size of the diverticulum or diverticula - 1 -2 times per year). Patients should strictly observe the 4-5-times diet, not eat sharp, fried and too fatty foods (especially given the frequent combination of duodenal diverticula with cholelithiasis, peptic ulcer and pancreatitis), eat slowly and thoroughly chew food.
Diverticulum treatment of the jejunum and ileum. With large diverticula, surgical treatment is indicated. Urgent operations are performed with perforation of the diverticulum wall, torsion of its pedicle, massive intestinal bleeding, caused by ulceration of the mucous membrane of the diverticulum. With uncomplicated single small diverticula, no special treatment is required. However, patients are recommended to include bran in the diet, thoroughly chew food, do not use sharp condiments, follow the emptying of the intestine.
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