Small bowel diverticula: treatment

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. It is necessary timely sanation of sick teeth and special care when eating small-boned fish, chicken dishes, possibly containing small fragments of bones; not to be distracted while eating, talking, reading, etc., because, not observing these recommendations, you can swallow a foreign body - bones, unrefined chunks of food, especially meat, and contribute to their delay in the diverticulum.

Obligatory simultaneous treatment of concomitant diseases (cholecystitis, pancreatitis, etc.). Given the relatively frequent combination of diverticulum of the duodenum with diverticula of other localization, it is expedient at first to identify a diverticulum of the duodenum, and then, once every few years, conduct a contrast radiographic examination of the entire digestive tract, especially the large intestine, where diverticula most often occur, to identify them in time and try to prevent the occurrence of complications.

With the development of complications of diverticulum of the duodenum (pronounced diverticulitis, bleeding from the erosive wall of the diverticulum, perforation, etc.), urgent hospitalization is recommended in the surgical department of the hospital and surgical treatment. Scheduled operations are indicated for large sizes of diverticulum (or diverticulosis), when combined with cholelithiasis, a hard scarring ulcer of the duodenal bulb and in other similar cases.

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. Since small swallowed bones of fruits and berries can get into the diverticulum and stay in it, before using them for food, patients must first remove the bones. Bismuth basic nitrate is indicated in mild cases of diverticulitis; spastic pains are prescribed myotropic antispasmodics (papaverine hydrochloride, no-spa), and metoclopramide (cerulek, raglan).

When an ileal diverticulum is detected, especially in small sizes (for example, with fluoroscopy performed on a different occasion), surgical intervention is hardly advisable. However, patients should be warned about the presence of this disease, possible complications and the need to periodically see a doctor. With large diverticula and the occurrence of complications, surgical treatment is necessary.

The prognosis of diverticular disease of the small intestine with single diverticula and uncomplicated course is usually favorable. Dietary fiber has a protective effect against diverticular disease, if taken more than 100 g / day.

[1], [2], [3], [4], [5], [6], [7], [8], [9]