Colon diverticula: symptoms

On the basis of clinical features, asymptomatic diverticula, uncomplicated diverticular disease and diverticular disease with complications are distinguished.

Uncomplicated diverticular disease of the colon. For a long time, there was a perception that the uncomplicated diverticular disease of the large intestine was asymptomatic. The work of recent decades indicates the presence in most patients with uncomplicated diverticula clinical manifestations. Diverticula were asymptomatic in only 14% of cases of uncomplicated diverticulosis and in 5% of all cases of their detection.

A characteristic symptom of uncomplicated diverticulosis of the colon is pain, the localization of which, as a rule, corresponds to the location of diverticula, i.e., more often in the left lower quadrant. The pain is usually short, relapsing, sometimes radiating back and forth. It is often relieved after stools and gases. Constipation is often observed, mainly not having the character of persistent, transient diarrhea, often their replacement. Many patients have flatulence. Less often patients complain about the lack of a feeling of complete emptying of the bowel after defecation. When palpation of the abdomen in a number of cases, the spastic contraction and soreness of the affected bowel area is determined.

Thus, uncomplicated diverticular disease of the colon has symptoms of functional disorders. Relatively rare, it is asymptomatic.

Complications of diverticular disease of the colon. Diverticulitis occupies a special place. Diverticula in the colon already at the time of their detection in most cases have signs of diverticulitis. Sometimes the first signs of the disease appear only with the development of the inflammatory process in the diverticula.

In the clinical picture of diverticulitis, the main symptom is abdominal pain, especially in the left lower quadrant, which is indicated practically by all patients. Frequent transient or permanent constipation, intermittent diarrhea or their change. Flatulence is often observed. Multiple defecation, tenesmus, absence of sensation of complete emptying of the intestine after the stool is marked by patients with sigma diverticulitis. Possible pathological impurities in feces (mucus, blood, less often pus). Sometimes there is dysuria, which is caused by the spread of inflammation from the colon to the bladder or the formation of adhesions with it.

Characteristic common manifestations of inflammation: fever, chills, acceleration of ESR, hyperleukocytosis with a stab-shift.

Exacerbation of chronic diverticulitis is sometimes accompanied by nausea, vomiting, general weakness, lack of appetite, weight loss.

At physical examination at a chronic diverticulitis during an exacerbation the symptom of percussion soreness on the limited site, a strain of muscles can be revealed. With deep palpation in almost all cases, even outside the exacerbation, the soreness of the affected segment of the intestine is determined. Often, the compaction of the gut region is felt, sometimes a tumor-like formation, indistinctly delimited, with an uneven surface.

Outside the period of exacerbation of chronic diverticulitis, the patients' ability to work has been preserved.

There are 3 variants of the clinical course of chronic diverticulitis: latent, colitis-like and in the form of "abdominal crises".

Latent variant. Diverticulitis can last for a long time without noticeable disability. However, there are certain anamnestic and diagnostic signs: episodic pain, stool disorders, flatulence.

Colitis-like variant. Pain in the abdomen is a concern often. Observed pronounced constipation or diarrhea, often worried bloating. Often there is an admixture of mucus, blood in the feces. Sometimes the body temperature rises, usually to subfebrile. Soreness upon palpation of the affected area of the colon becomes pronounced.

Option in the form of "abdominal crises." Most often, chronic diverticulitis occurs with attacks of abdominal pain resembling acute abdominal disease. Characteristic is the sudden "onset" of the disease, and subsequently its exacerbations. There is a local abdominal pain, increasing in intensity, which later becomes common. The temperature rises for several hours - 2 days, often chills. Constipation becomes more stubborn or diarrhea occurs, flatulence occurs. There is an admixture of mucus, blood in the feces, sometimes pus. Symptoms of irritation of the peritoneum may be determined. The affected area of the intestine becomes sharply painful upon palpation. In the future, infiltration can be probed. With the reverse development of the inflammatory process, clinical manifestations gradually subside.

This variant of diverticulitis is described as "left-sided appendicitis" because of the similarity of its symptoms with manifestations of appendicitis. It is with this variant of the course of chronic diverticulitis that there is often a microperforation of the diverticulum or the formation of intestinal microabscesses.

Chronic diverticulitis is characterized by a persistent current. Exacerbation of chronic diverticulitis quickly enough stops with timely treatment, but a typical tendency to relapse.

Intestinal bleeding in diverticular disease of the colon occurs in 9-38% of cases. The high frequency of this complication is due to the proximity of the diverticula to the blood vessels. The source of bleeding can also be a swollen mucosa and granulation tissue. More often bleeding occurs with diverticulitis, but it is possible and in the absence of inflammation due to trauma of the blood vessel. Bleeding atherosclerosis and hypertension, often associated with diverticular disease, contribute to bleeding.

Intestinal bleeding can be massive (2-6%) and (more often) meager, in the form of unchanged blood and tarry stools, single and recurrent. Often, bleeding is the first manifestation of the disease.

Intestinal obstruction. The frequency of intestinal obstruction, according to various authors, varies from 4 to 42%. The cause of intestinal obstruction may be the development of an inflammatory infiltrate, narrowing or squeezing the gut, an adhesion process leading to deformation of the gut or its mesentery. Sometimes it occurs in chronic diverticulitis as a result of a spasm of smooth muscles combined with reversible inflammatory changes in the wall of the bowel.

With the development of the narrowing of the intestine due to diverticulitis, differential diagnosis with neoplasm may be difficult. In the tumor conglomerate sometimes also includes loops of the small intestine, so in some cases develops small intestinal obstruction.

Perforation of the diverticulum. According to most researchers, perforation of the diverticulum is the most frequent complication of diverticulitis. Its cause is the spread of the inflammatory process to the depth of the diverticulum wall and an increase in intestinal pressure. Of great importance is the pressure of stool, which can lead to necrosis of the wall of the diverticulum. Perforation is also possible in the absence of inflammation in the diverticulum due to a sudden increase in pressure in the gut lumen.

There is a free and covered perforation of the diverticulum. With a slow progression of inflammation, the serous membrane "glues" with the surrounding organs, there is a covered perforation. With chronic diverticulitis, microperforations are often frequent, often reopened, not always diagnosed even with laparoscopy. Such small perforations clinically manifest as acute or exacerbation of chronic diverticulitis.

Peritonitis. Diverticulitis as the cause of peritonitis is in fourth place after appendicitis, perforated ulcers of the stomach and duodenum and ileus. The development of peritonitis can be associated with perforation of the diverticulum, rupture of the abscess, spread of inflammation outside the colon.

Abscesses (frequency 3-21%) can occur inside the intestinal wall with inflammation and edema of the neck of an incomplete pseudodiverticle and its obstruction. More often they are formed as a result of the covered perforation of the diverticulum. When a diverticular abscess is often probed tumor-like formation, which must be differentiated from carcinoma.

Fistulas (frequency 1-23%) are formed during perforation of the diverticulum and with the breakthrough of the abscess. The most common enteric-fistula fistulas. Most often they are found in men, as in women between the bowel and the bladder is the uterus. Less common are fistulas with ureter, vagina, uterus, other parts of the colon, small intestine, intestinal fistula. Diverticulitis of the right half of the colon is rarely complicated by the formation of a fistula with a gallbladder.

Perivistserite. Chronic diverticulitis often leads to the development of perivistercite. This is facilitated by a thin wall of a false diverticulum. However, it is impossible to judge the true prevalence of this complication, since pericolitic phenomena with instrumental examination and laparotomy are relatively rare.

Rarely occurring complications. With diverticulitis occasionally there are purulent flebiti of the portal vein and its branches with abscessing of the liver, lungs, brain, sepsis, twisting of the diverticulum, massive bleeding from the iliac artery abscessed with diverticular abscess.

Accompanying illnesses. Diverticular disease of the colon is often combined with hernias of the anterior abdominal wall, varicose veins of the lower extremities, diverticula of the small intestine, bladder, hemorrhoids. Often found a combination of it with calculous cholecystitis and hernia of the esophagus of the diaphragm - the triad of Sent. Apparently, there are common factors predisposing to the occurrence of each of these diseases. These include, on the one hand, increased intra-abdominal pressure, which contributes to the development of diverticula, and hernia of the esophageal aperture of the diaphragm, and on the other hand, cholestasis, favorable for the formation of calculi. The combination of a diverticular disease with a cancer of a colon, according to the majority of researchers, does not exceed frequency of the last among persons of elderly and senile age. Individual authors often described a combination of diverticular disease of the colon with polycystic kidney disease and bronchiectasis.

The prognosis for diverticular disease in most cases is favorable, but it can lead to the development of severe, even life-threatening complications. This is due not only to the severity of the complications themselves, but also to the primary lesion of elderly and senile people, often having concomitant diseases, less resistance in this age group.

[1], [2], [3], [4], [5], [6]