Treatment of diverticulosis of the intestine

Treatment of diverticulosis of the intestine is aimed at improving the quality of life of patients with diverticular disease, for this it is necessary to stop the symptoms.

Timely treatment of acute diverticulitis to prevent life-threatening complications. Criteria for the effectiveness of treatment for diverticulitis are the achievement of clinical-laboratory remission or at least relief of acute inflammatory process, pain syndrome. Prevention of complications of diverticular disease.

Indications for hospitalization

Diverticulosis of the intestine without diverticulitis or outside the exacerbation of chronic diverticulitis is treated on an outpatient basis. The need for hospitalization arises in the following cases:

• acute diverticulitis (exacerbation of chronic diverticulitis);
• marked intoxication;
• inability to eat through the mouth;
• the patient is over 85 years of age;
• severe co-morbidities;
• high fever (39-41 ° C);
• symptoms of irritation of the peritoneum;
• pronounced leukocytosis - more than 15x10 ⁹ / l (in old age it may not be);
• presence of immunosuppression in the patient, including iatrogenic, for example, due to the intake of glucocorticoids.

Indications for specialist consultation

When developing complications of diverticulosis of the intestine, it is necessary to involve the surgeon both for consultations and for determining indications for surgical treatment.

Non-drug treatment of diverticulosis of the intestine

Mode

It is necessary to abandon cleansing enemas and, if possible, laxatives. A beneficial effect is the expansion of physical activity due to accelerated passage of intestinal contents and a decrease in pressure in the lumen of the intestine.

Diet

Patients with uncomplicated diverticular disease are recommended to enrich their diet with dietary fiber (except very rough fiber: turnip, radish, radish, pineapple, persimmon) - more than 32 g / day, because dietary fibers reduce pressure in the colon lumen.

If the diet is poorly tolerated, the use of foods rich in dietary fiber, in crushed form, and vegetables after culinary processing is recommended. The restriction of gas-forming products (cabbage, grapes, etc.), exclusion of legumes, carbonated beverages is shown. It is necessary to use a sufficient amount of liquid - 1.5-2 liters (in the absence of contraindications).

The exclusion of products containing small seeds and nuts is not currently recommended.

[1], [2]

Medicinal treatment of diverticulosis of the intestine

Uncomplicated diverticulosis of the intestine

The following groups of medicines are used as an outpatient for diverticulosis of the intestine.

• Spasmolytics
• Calcium channel blockers: mebeverine (200 mg 2 times a day), pinaverium bromide (50 mg 3 times a day).
• Holinoblokatory: hyoscine butybromide. Platyphylline.
• Myotropic antispasmodics: papaverine, benzyclan or drotaverine chloride.

The appointment of antispasmodics leads to a reduction in the pain syndrome. The dose, duration and mode of administration are selected individually.

Means for the regulation of stools

Avoid stimulant laxatives, as they can increase pressure in the gut and cause pain. It is recommended to take osmotic laxatives and funds that increase the volume of intestinal contents. Osmotic laxative for the regulation of stool - lac-tulose. The initial dose of 15-45 ml per day, maintaining a dose of 10-30 ml per day in one morning. Correction of the dose is carried out after 2 days in the absence of effect. Plantain seed coat - a preparation from shells of seeds of Indian plantain Plantago ovata . Recommended intake of the drug in a dose of 2-6 bags per day. The effect is due to softening of intestinal contents and increase in its volume. With diarrhea syndrome - astringents, adsorbents (smectite dioctahedral, preparations of bismuth). In meteorism, adsorbents, simethicone are prescribed. Precautions: should avoid the use of drugs of the group of morphine and similar in structure of synthetic compounds that increase the tone of smooth muscles.

Acute diverticulitis

With acute diverticulitis or exacerbation of chronic diverticulitis, hospitalization in the surgical (proctologic) hospital, infusion therapy with plasma-substituting and detoxifying solutions, the prescription of broad-spectrum antibacterial drugs that penetrate well into tissues and are active against the intestinal microflora (cephalosporins of the second generation, nitroimidazoles, fluoroquinolones and other).

The first stage (the beginning and at the height of inflammation) - 7-10 days. For 2-3 days completely eliminate the intake of food and prescribe oral and parenteral rehydration. The latter is preferable in the severe condition of the patient. After a few days, carefully dilate the diet. The appointment of a diet enriched with dietary fiber is possible only after the complete resolution of acute diverticulitis. When vomiting, bloating, the introduction of the nasogastric tube is indicated. Carry out detoxication therapy. Apply antibiotics, effective against gram-negative and anaerobic microflora. The following schemes are possible:

• monotherapy - second-generation csphalosporin or protected penicillin (the effectiveness of monotherapy, according to some studies, is not inferior to that of several antibiotics);
• treatment with two antibiotics: a drug active against anaerobic microflora, + aminoglycoside, third generation cephalosporin or monobactam; treatment with three antibiotics: ampicillin, gentamycin and metronidazole.

In the absence of the effect of treatment after 2-3 days, the formation of an abscess should be ruled out.

With a moderately pronounced inflammatory process (no intoxication, signs of irritation of the peritoneum, normal or subfebrile body temperature), antibiotics are given orally. The most convenient amoxicillin + clavulanic acid (protected penicillin) inside at a dose of 875 mg every 12 hours.

[3], [4], [5], [6], [7], [8]

Preparations and Dosages

Cefoxytin (second generation cephalosporin) - 2 g IV every 6 h.

Ampicillin + sulbactam (protected penicillin) - 3 g IV every 6 h.

Ticarcillin + clavulanic acid (protected penicillin) - 3.1 g IV every 6 hours.

Imipenem + cilastatin (p-lactam antibiotic) - 500 mg IV every 6 hours.

Metronidazole 500 mg IV every 6 hours in combination with (one of the options):

• gentamycin in a daily dose of 3-5 mg / kg, divided into 2 ~ 3 administration;
• ceftriaxone in a dose of 1 g IV every 24 hours; ciprofloxacin in a dose of 400 mg IV every 12 hours.

Ampicillin in a dose of 2 g IV every 6 hours in combination with gentamicin in a daily dose of 3-5 mg / kg, divided into 2-3 injections, and metronidazole 500 mg IV every 6 hours.

Spasmolytic drugs and anticholinergic drugs are prescribed for parenteral pain. The regulation of intestinal function is shown: with constipation, Vaseline oil (no longer than 5-7 days), macrogol, plantain seed coat; with diarrhea - adsorbents, astringents.

The second stage (stagnation of inflammation) - 7-10 days. The diet is gradually expanded. According to the indications, antibacterial treatment is continued (at the same time, the drug must be changed). They regulate intestinal motility, and carry out vitamin therapy.

The third stage is maintenance therapy and observation. Performed on an outpatient basis. A complex of measures is shown, similar to that in the treatment of diverticular disease outside the exacerbation of diverticulitis.

Surgical treatment of diverticulosis of the intestine

Operative treatment of the diverticulosis of the intestine is indicated for complications of the disease that pose a direct threat to the life of the patient - the perforation of the diverticulum into the abdominal cavity, intestinal obstruction, profuse bleeding, the presence of fistulas (interintestinal, intestinal-vesical, intestinal-vaginal), recurrent diverticulitis complicated by abscessing. Treatment of diverticulosis of the intestine is carried out in the surgical department.

A cinnamon abscess is a wait-and-see tactic (with abscesses less than 2 cm in size near the mesentery of the large intestine, conservative tactics justify themselves). Pelvic, retroperitoneal abscesses, peritonitis are indications for surgical treatment. With abscesses, it is possible to perform percutaneous drainage under X-ray control.

The choice of the method of operation in each specific case depends on a number of factors: the nature of the complications, the prevalence of the process, inflammatory changes in the tissue of the diverticulum, the intestinal wall and surrounding tissues, the presence of perifocal inflammation or peritonitis. A major role is played by concomitant diseases, often observed in elderly streets. It is preferable to perform resection of the large intestine in a planned manner with simultaneous application of anastomosis. The operation is performed after 6-12 honey after the arrest of an acute attack of diverticulitis.

Tactics of reference

Asymptomatic bowel diverticulosis, diagnosed accidentally, does not require special treatment. In order to prevent the progression of the disease and prevent possible complications, the patient is recommended a diet rich in vegetable fiber.

At a diverticulosis with the expressed signs apply a complex of medical actions: a weakening diet, antispasmodics, the preparations regulating motor function of an intestine. In the majority of patients with clinically expressed diverticular disease of the colon, conservative treatment of diverticulosis of the intestine produces a lasting positive effect.

When diverticulitis shows the appointment of antibiotics, intestinal antiseptics, osmotic laxatives.

Further management of the patient

An annual examination of the doctor and a routine examination on an outpatient basis are shown.

After the resolution of acute diverticulitis, a survey is necessary to exclude another pathology of the colon (primarily cancer, found in 6% of patients with diverticular disease) - a colonoscopy is performed 1 month after the resolution of the diverticulitis.

After the resolution of the diverticulitis, careful observation is necessary to exclude its complications (abscess, fistula, stenosis of the intestine): careful collection of anamnesis, if necessary, an overview radiography of the abdominal cavity, irrigoscopy with a barium enema, CT of the abdominal cavity.

When observing a patient with a diverticular disease, timely detection of diverticulitis is necessary, the main clinical manifestations of which are abdominal pain and fever.

Patient education

The patient must provide full information about his disease, warn about the signs and the danger of acute diverticulitis.

Detailed dietary recommendations should be given.

It is necessary to advise the patient to increase physical activity.