Symptoms of diverticulosis of the intestine

Diverticulosis of the intestine can cause nonspecific complaints from the intestine - abdominal pain, constipation, diarrhea, flatulence. To establish the diagnosis and exclude other causes of nonspecific complaints, visualization of the diverticulum (diverticulum) is necessary with the help of a colonoscopy or an irrigoscopy with a barium enema, CT of the abdominal cavity.

With the development of complications, the clinical symptoms of diverticulosis of the intestine become brighter (severe abdominal pain, increased body temperature, other signs of intoxication, signs of fistula formation or partial intestinal obstruction). In view of the possibility of acute surgical pathology, diagnostic measures (laboratory and instrumental examination) are performed in a surgical hospital.

There are several clinical forms of intestinal diverticulosis.

Asymptomatic diverticulosis

70% of individuals do not have the symptoms of an intestinal diverticulosis. Anamnesis and physical examination in such cases do not give information about the presence of a diverticulum.

[1], [2], [3], [4], [5]

Uncomplicated diverticulosis with clinical symptoms

Symptoms of diverticulosis are nonspecific: abdominal pain (usually in the left iliac region, intensified during food intake, subsided after defecation), bloating, unstable stool - alternating constipation, diarrhea and normal stool. There may be a mucus in the stool. The increase in body temperature for uncomplicated diverticulosis is not typical.

Diverticulum of small intestine

Diverticulum of the small intestine is more often asymptomatic. Rarely can lead to a stasis of intestinal contents, a syndrome of excessive bacterial growth and associated malabsorption. Complications (perforation, inflammation and bleeding) are much less common than with diverticula of the colon.

[6], [7], [8], [9],

Single diverticulum of the duodenum

A single diverticulum of the duodenum is usually asymptomatic. It is located more often near the large duodenal papilla (parafataral diverticulum) or in the bulb of the duodenum. The last localization is typical for patients with recurrent ulcer of the bulb of the duodenum.

Multiple diverticula of the small intestine

Multiple diverticula of the small intestine are usually located on the mesenteric margin of the intestine. Diverticulosis is asymptomatic until inflammation joins as a result of microbial contamination of these parts of the intestine. Bleeding from Meckel's diverticulum is observed with its inflammation (diverticulitis). Diverticulitis and perforation of Meckel's diverticulum resemble acute appendicitis in the clinical picture.

Diverticulosis of the large intestine

Diverticulosis of the colon has the following symptoms: regular pains more often in the left ileal region, less often in the course of other parts of the colon, disappearing after the act of defecation. Pain is present, as a rule, for several weeks, months. Constipation (feces in the form of balls with an admixture of mucus). Bloating and heavy discharge of gases. Symptoms caused by often accompanying diverticulosis with cholecystolithiasis and hernia of the esophagus of the diaphragm (the Seinth triad).

[10], [11], [12], [13]

Diverticulosis with a complicated course

[14], [15], [16], [17], [18]

Acute diverticulitis

For acute diverticulitis, an increase in body temperature and other symptoms of inflammation are typical: abdominal pain (usually in the left lower quadrant of the abdomen, but possible in the peri-ocular and right iliac regions - respectively, localization of diverticula) in combination with diarrhea or constipation, weakness, lack of appetite, nausea, vomiting. Diverticulitis develops in 10-25% of patients.

[19], [20], [21], [22], [23], [24], [25]

Perforation

When perforating the diverticulum into the abdominal cavity, a clinic of diffuse peritonitis develops. When perforating a diverticulum into the retroperitoneal tissue or space between the leaves of the mesentery, infiltrates or abscesses occur. Covered perforation occurs with a slow progression of inflammation, during which the serous membrane adheres to surrounding organs. The development of peritonitis can be associated not only with the perforation of the diverticulum, but also with abscesses that appear 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 bleeding from the lower gastrointestinal tract. With diverticular disease, bleeding occurs in 20-25% of cases, often acting as the first and only manifestation of the disease. Usually, bleeding is associated with ulceration of the neck or the wall of the diverticulum and the vessel passing there as a result of chronic inflammation or the formation of pressure ulcers in the place of stool. Bleeding from non-inflamed diverticulum may occur in patients with essential arterial hypertension, atherosclerosis, heart disease, blood diseases, diabetes mellitus and long-term use of glucocorticoids. The amount of blood loss varies: from a minor admixture of blood in the fecal masses (sometimes latent bleeding) to massive profuse bleeding, accompanied by collapse and sometimes leading to death.

[26], [27], [28], [29]

Intestinal obstruction

The cause of intestinal obstruction may be an inflammatory infiltrate, a squeezing gut, an adhesion process leading to deformation of the intestine and its mesentery, in some cases - intussusception of the intestine with diverticulum or spasm of smooth musculature. Intestinal obstruction with diverticulosis often has an obturation character with all manifestations inherent in this form.

Internal or, more rarely, external intestinal fistulae

In men, sigmovesical fistulas develop more often, in women - sigmovaginal fistulas. In the formation of internal fistulas, a complex system of fistulous passages can be formed that open onto the skin of the anterior abdominal wall. When the intestinal-urobubic fistula is formed, pneumaturia, fecaluria, with sigmovaginal fistula - the release of fecal masses through the vagina.

Possible physical signs of complications

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