Small Intestine Diverticula - Symptoms

In most cases, duodenal diverticula proceed more or less asymptomatically for a long time or manifest themselves with mild dyspeptic symptoms, mainly arising after disturbances in the usual rhythm and nature of nutrition. However, severe complications are also possible, most often arising suddenly, after gross deviations from normal generally accepted dietary norms, which manifest themselves with pronounced symptoms and often threaten the patient's life: diverticulitis, bleeding, perforation, etc.

Course and complications. The course of the disease may be quite favorable for some time, asymptomatic or almost asymptomatic, but it becomes much more severe with the development of complications. Complications of duodenal diverticula include foreign body getting stuck in it (especially in large diverticula), long-term retention of food masses in it (with a narrow neck of the diverticulum) - all this creates conditions (due to abundant reproduction of various bacterial flora in the diverticulum) for the development of an inflammatory process - diverticulitis and peridiverticulitis, ulceration of its mucous membrane, perforation of the wall (including with the development of peritonitis), bleeding, often profuse. The literature describes isolated cases of death of patients from bleeding from a diverticulum. In one case, a duodenal diverticulum perforated into the abdominal aorta, which caused fatal bleeding. A tumor may develop in the diverticulum.

Symptoms of jejunum and ileum diverticula. In most cases, jejunum and ileum diverticula are asymptomatic and are discovered accidentally during X-ray examination of the gastrointestinal tract or during autopsy. However, if the diverticulum has a narrow lumen connecting it to the intestine and is poorly emptied, chyme stagnates in it, sometimes small foreign bodies (chicken bones, fruit stones, etc.), diverticulitis and peridiverticulitis may develop. In this case, abdominal pain, symptoms of dyspepsia occur, in severe cases the temperature rises, signs of general intoxication appear, and ESR increases. A distinction is made between catarrhal (the most common), purulent (phlegmonous) and gangrenous forms of diverticulitis. In the gangrenous form, perforation is possible due to necrosis of the wall. Sometimes an intestinal diverticulum causes bleeding when a large vessel is damaged.

Formation of a fecal stone in a diverticulum with subsequent development of intestinal obstruction has been described. An interesting syndrome was described in 1954 by J. Badenoch and PD Bedford, which included a triad of signs: multiple diverticula of the jejunum, steatorrhea and megaloblastic anemia. Ten years later, 25 cases of this syndrome were described in the literature. Prescription of vitamin B12 and antibiotics proved effective in a number of cases with the described syndrome.

A special place among the diverticula of the small intestine is occupied by the ileal diverticulum, which differs from other diverticula in its origin. It was first described by Meckel in 1809. This is a congenital anomaly caused by incomplete closure of the vitelline or umbilical-intestinal duct (ductus ornphalomesentericus). In the embryonic period, this duct connects the yolk sac with the midgut, through which the human embryo receives nutrition in the first months of life. Then the embryo is nourished by the nutrients of the mother's blood, and the duct usually overgrows by the end of the 3rd month of intrauterine development (less often - in the 5th-9th month). In the case of its incomplete overgrowth in the postnatal period, a diverticulum-like formation remains, localized on the wall of the small intestine, opposite the side of attachment of the mesentery, at a distance of 40-50 cm from the ileocecal valve. In most cases (more than 80%), this blind diverticulum-like protrusion of the intestinal wall is 4-6 cm long; the longest ileal diverticulum 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 may remain unclosed. Then it is a tubular formation directed toward the umbilicus or ending in a fibrous cord connected to the umbilicus. It is considered to be one of the most common congenital anomalies: it is detected at autopsy in 1-3% of cases. Ileal diverticulum (Meckel's) is sometimes combined with congenital anomalies not only of the digestive system, but also of other organs.

Clinically, ileal diverticulum most often manifests itself in the first years of a child's life. In adults, it is either asymptomatic or accompanied by vague pain in the paraumbilical and ileal regions. In men, ileal diverticulum occurs approximately 3 times more often than in women, and is usually accompanied by clinical symptoms, mainly due to the occurrence of an inflammatory process in the diverticulum wall, ulceration of its mucous membrane and bleeding.

Diverticulitis (chronic and acute) sometimes occurs with appendicitis-like symptoms, which is a reason for hospitalizing patients with diverticulitis in a surgical hospital. In this case, a thorough revision of the distal part (about 1 m) of the ileum is necessary so as not to miss the diverticulum. Peptic ulcers of the ileal diverticulum, according to some authors, occur with atypical pain, while others - with a characteristic ulcer-like syndrome. Less often, symptoms of intestinal obstruction occur - in 3% of cases, or a tumor develops in the diverticulum. Foreign bodies can be retained in the Meckel's diverticulum, most often small chicken and fish bones, fruit and berry pits.

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