Small Intestine Diverticula - Treatment

Treatment of duodenal diverticula in the absence of pronounced symptoms of the disease is limited to medical observation of the patient (initially once every 3-6 months, then, if the disease is "calm", the patient strictly follows the doctor's recommendations and there are no signs of a significant increase in the size of the diverticulum or diverticula - 1-2 times a year). Patients should strictly adhere to a 4-5-meal regimen, avoid spicy, fried and too fatty foods (especially considering the frequent combination of duodenal diverticula with gallstones, peptic ulcer disease and pancreatitis), eat slowly and chew food thoroughly. Timely sanitation of diseased teeth is necessary and special care is needed when eating small-boned fish, chicken dishes, possibly containing small bone fragments; Do not be distracted while eating by talking, reading, etc., since if you do not follow these recommendations, you can swallow a foreign body - bones, unchewed pieces of food, especially meat, and contribute to their retention in the diverticulum.

Simultaneous treatment of concomitant diseases (cholecystitis, pancreatitis, etc.) is mandatory. Given the relatively frequent combination of duodenal diverticula with diverticula of other localizations, it is advisable to initially, upon detection of a duodenal diverticulum, and then, every few years, conduct a contrast radiographic examination of the entire digestive tract, especially the colon, where diverticula most often occur, in order to detect them in a timely manner and try to prevent the occurrence of complications.

In case of complications of duodenal diverticula (obvious diverticulitis, bleeding from the eroded wall of the diverticulum, perforation, etc.), emergency hospitalization in the surgical department of the hospital and surgical treatment are recommended. Elective operations are indicated for large diverticula (or diverticulosis), in combination with gallstone disease, hard-to-heal ulcer of the duodenal bulb, and in other similar cases.

Treatment of diverticula of the jejunum and ileum. Surgical treatment is indicated for large diverticula. Emergency operations are performed in case of perforation of the diverticulum wall, torsion of its stalk, massive intestinal bleeding caused by ulceration of the diverticulum mucosa. Special treatment is not required for uncomplicated isolated diverticula of small sizes. However, patients are advised to include bran in their diet, chew food thoroughly, avoid hot spices, and monitor bowel movements. Since small swallowed fruit and berry seeds can get into the diverticulum and be retained there, patients should remove the seeds before eating them. Basic bismuth nitrate is indicated in mild cases of diverticulitis; for spastic pain, myotropic antispasmodics (papaverine hydrochloride, no-shpa) and metoclopramide (cerucal, reglan) are prescribed.

If an ileal diverticulum is accidentally detected, especially if it is small (e.g., during X-ray examination performed for another reason), surgical intervention is unlikely to be advisable. However, patients should be warned about the presence of this disease, possible complications, and the need for periodic medical observation. In case of large diverticula and the occurrence of complications, surgical treatment is necessary.

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

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