Symptoms of intestinal diverticulosis

Diverticulosis of the intestine may be the cause of non-specific complaints from the intestine - abdominal pain, constipation, diarrhea, flatulence. To establish a diagnosis and exclude other causes of non-specific complaints, visualization of the diverticulum (diverticula) is necessary using colonoscopy or irrigoscopy with barium enema, CT of the abdominal cavity.

With the development of complications, the clinical symptoms of intestinal diverticulosis become more pronounced (severe abdominal pain, elevated body temperature, other signs of intoxication; signs of fistula formation or partial intestinal obstruction are possible). Due to the possibility of acute surgical pathology, diagnostic measures (laboratory and instrumental examination) are carried out in a surgical hospital.

There are several clinical forms of intestinal diverticulosis.

Asymptomatic diverticulosis

70% of individuals have no symptoms of intestinal diverticulosis. In such cases, the history and physical examination do not provide information about the presence of a diverticulum.

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Uncomplicated diverticulosis with clinical symptoms

Symptoms of diverticulosis are non-specific: abdominal pain (usually in the left iliac region, intensifies during meals, subsides after defecation), bloating, unstable stool - alternating constipation, diarrhea and normal stool. Mucus may appear in the stool. An increase in body temperature is not typical for uncomplicated diverticulosis.

Diverticula of the small intestine

Small intestinal diverticula are often asymptomatic. Rarely, they can lead to intestinal stasis, bacterial overgrowth syndrome, and associated malabsorption. Complications (perforation, inflammation, and bleeding) are much less common than with colonic diverticula.

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Solitary diverticulum of the duodenum

A solitary duodenal diverticulum is usually asymptomatic. It is most often located near the large duodenal papilla (paraphateral diverticulum) or in the duodenal bulb. The latter localization is typical for patients with recurrent ulcers of the duodenal bulb.

Multiple diverticula of the small intestine

Multiple diverticula of the small intestine are usually located on the mesenteric edge of the intestine. Diverticulosis is asymptomatic until inflammation occurs as a result of microbial contamination of these parts of the intestine. Bleeding from Meckel's diverticulum is observed when it is inflamed (diverticulitis). Diverticulitis and perforation of Meckel's diverticulum resemble acute appendicitis in clinical presentation.

Diverticulosis of the colon

Diverticulosis of the colon has the following symptoms: regularly occurring pain, more often in the left iliac region, less often along other parts of the colon, disappearing after defecation. The pain is present, as a rule, for several weeks, months. Constipation (feces in the form of balls with an admixture of mucus). Bloating and abundant gas. Symptoms caused by cholecystolithiasis and hernia of the esophageal opening of the diaphragm (Saint's triad), which often accompany diverticulosis.

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Diverticulosis with complicated course

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Acute diverticulitis

Acute diverticulitis is characterized by fever and other symptoms of inflammation: abdominal pain (usually in the left lower quadrant of the abdomen, but may occur in the umbilical and right iliac regions - respectively, the localization of the diverticula) combined with diarrhea or constipation, weakness, loss of appetite, nausea, vomiting. Diverticulitis develops in 10-25% of patients.

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Perforation

Perforation of the diverticulum into the abdominal cavity results in the development of diffuse peritonitis. Perforation of the diverticulum into the retroperitoneal tissue or the space between the mesenteric layers results in infiltrates or abscesses. Covered perforation occurs with slow progression of inflammation, during which the serous membrane adheres to the surrounding organs. The development of peritonitis may be associated not only with perforation of the diverticulum, but also with abscesses that occur in the thickness of the intestinal wall, with inflammation and edema of the neck of the diverticulum with its obstruction.

Bleeding

Diverticula are the most common cause of lower gastrointestinal bleeding. In diverticular disease, bleeding occurs in 20-25% of cases, often being the first and only manifestation of the disease. Bleeding is usually associated with ulceration of the neck or wall of the diverticulum and the vessel passing through it as a result of chronic inflammation or the formation of a pressure ulcer at the site of a fecal stone. Bleeding from a non-inflamed diverticulum can occur in patients with essential arterial hypertension, atherosclerosis, heart disease, blood disease, diabetes mellitus, and with long-term use of glucocorticoids. The volume of blood loss varies: from a slight admixture of blood in the feces (sometimes hidden bleeding) to massive profuse bleeding, accompanied by collapse and sometimes leading to death.

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Intestinal obstruction

The cause of intestinal obstruction may be an inflammatory infiltrate compressing the intestine, an adhesive process leading to deformation of the intestine and its mesentery, in some cases - intussusception of a part of the intestine with a diverticulum or a spasm of smooth muscles. Intestinal obstruction in diverticulosis is more often of an obstructive nature with all the manifestations inherent in this form.

Internal or, less commonly, external intestinal fistulas

Sigmovesical fistulas are more common in men, and sigmoidovaginal fistulas are more common in women. When internal fistulas form, a complex system of fistula tracts may form, opening onto the skin of the anterior abdominal wall. When an intestinal-vesical fistula forms, pneumaturia and fecaluria occur, and when a sigmoidovaginal fistula forms, feces are released through the vagina.

Possible physical signs of complications

• tension of the muscles of the anterior abdominal wall in the left lower quadrant of the abdomen; symptoms of peritoneal irritation;
• palpable formation (abscess, peridiverticulitis in the form of a painful, dense, slightly mobile infiltrate);
• detection of blood during rectal examination.