Small bowel diverticula: symptoms

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.

Course and complications. The course of the disease can for some time be sufficiently favorable, asymptomatic or almost asymptomatic, but it sharply becomes heavier with the development of complications. Complications of the diverticulum of the duodenum are stuck in the foreign body (especially in large diverticula), prolonged retention in the food masses (with a narrow neck of the diverticulum) - all this creates conditions (due to abundant multiplication in the diverticula of a diverse bacterial flora) for the onset of the inflammatory process - diverticulitis and peridiverculitis, ulceration of its mucosa, perforation of the wall (including the development of peritonitis), bleeding, often abundant. In the literature, individual cases of death of patients from bleeding from a diverticulum are described. In one case, there was a perforation of the duodenum diverticulum into the abdominal aorta, which caused fatal bleeding. In the diverticulum, the development of a tumor is possible.

Symptoms 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.

The formation in the diverticulum of calcareous stone with the subsequent development of intestinal obstruction is described. An interesting syndrome was described in 1954 by J. Badenoch and PD Bedford, which included a triad of symptoms: multiple jejunal diverticula, steatori and megaloblastic anemia. After 10 years, 25 cases of this syndrome have been described in the literature. The appointment of vitamin B12 and antibiotics was in some cases effective in the described syndrome.

A special place among the diverticula of the small intestine is diverticulum of the ileum, which differs from other diverticula by its origin. It was first described by Meckel in 1809. It is a congenital anomaly caused by incomplete infection of the vitelline or umbilical duct (ductus ornphalomesentericus). In the embryonic period, this duct connects the yolk sac to the midgut through which the human embryo receives nutrition in the first months of life. Then the embryo feeds on the nutrients of the mother's blood, and the duct usually grows by the end of the 3rd month of intrauterine growth (less often - by the 5th-9th month). In case of its incomplete infection in the postnatal period, a diverticuloid-like formation remains localized on the wall of the small intestine, opposite the side of the mesentery attachment, at a distance of 40-50 cm from the ileocecal valve. In most cases (more than 80%) this blind diverticuloid-like bulging of the intestinal wall has a length of 4-6 cm; the longest diverticulum of the ileum, described by Mc.Murich, reached 104 cm. The diameter of the diverticulum varies widely and can reach the diameter of the ileum. In approximately 20% of cases, the entire duct can remain uninfected. Then it is a tubular formation directed toward the navel or ending with a fibrous cord connected to the navel. It is believed that this is one of the most common congenital anomalies: at autopsy it is found in 1-3% of cases. Diverticulum of the ileum (mekkel) is sometimes combined with congenital anomalies not only of the digestive system, but also of other organs.

Clinically, the diverticulum of the ileum is most often manifested in the first years of a child's life. In adults, it either occurs asymptomatically or is accompanied by vague pain in the para-umbilical and ileal regions. In men the diverticulum of the ileum occurs about 3 times more often than in women, and is usually accompanied by clinical symptoms, mainly due to the onset of inflammation in the wall of the diverticulum, ulceration of its mucosa and bleeding.

Diverticulitis (chronic and acute) sometimes occurs with appendicitis-like symptoms, which is the reason for the hospitalization of patients with diverticulitis in a surgical hospital. This requires a thorough revision of the distal part (about 1 m) of the ileum, so as not to miss the diverticulum. Peptic ulcers of the ileum diverticulum, according to some authors, occur with atypical pains, others - with a characteristic ulcerative syndrome. Less common symptoms of intestinal obstruction - in 3% of cases or in the diverticulum develops a tumor. In Meckelian diverticulum foreign bodies, most often small chicken and fish bones, fruit and berry seeds can be retained.

[1], [2], [3], [4], [5], [6], [7]