Colon diverticula: diagnosis

Recognizing diverticular disease is not an easy task. This is due to the absence of pathognomonic symptoms, the possibility of different localization of diverticula, and therefore pain, the main clinical sign of this suffering, the presence, as a rule, in elderly persons of concomitant diseases, the symptoms of which can mask the manifestations of diverticular disease. At the same time, early diagnosis of diverticular disease is extremely important because of the high potential risk of complications, often life-threatening. Assuming the diverticular nature of peritonitis, intestinal bleeding and other complications on the basis of clinical manifestations is possible only when it is already known that the patient has diverticula in the large intestine.

The leading method for the diagnosis of diverticular disease of the colon is X-ray, with irrigoscopy being preferred, since with oral colon filling with a suspension of barium sulfate, even approximately can not judge the number of diverticula. Hyper secretion, delay of contents in diverticula, aggravated with spasm, cervical edema, can prevent their detection. Therefore, careful preparation of the patient for research is important.

Diverticula are revealed in the form of additional cavities of round, finger-like shape, connected by an isthmus with the lumen of the intestine. More often they are located along the outer and inner contours, less often - along the entire circumference of the intestine. Diverticula are better defined after emptying the intestine from the bulk of the contrast medium injected into the enema, when they contain the remnants of it in the form of a plaque and are clearly visible on the background relief of the mucous membrane. Particularly distinctly diverticulums are seen in double contrast, since when they introduce air they expand, and the suspension of barium sulfate suspended in them emphasizes their contours. With tight filling, fewer diverticulums are found, because they overlap with a gut full of this suspension.

In diverticular disease of the colon with irrigoscopy, pronounced impairment of motor function can be determined: spasms, hypermotility of divisions of the gut containing diverticula, deformation of the gaustra, unevenness of emptying. These signs are often noted in diverticulosis and diverticulitis.

Barium enema should be placed only after the inflammation subsides due to the danger of perforation (not earlier than 7-14 days after the start of therapy) and in such situations double contrasting is not recommended.

Incomplete diverticula are rarely recognized as small depot of contrast medium (in the form of spots) inside the intestinal wall, connected by thin dashed-like channels with a lumen of the gut or in the form of similar channels, creating a harmonious contour of it. However, this radiographic evidence is not specific. It can occur when the full diverticula is not filled, the intestinal muscle is hypertrophic in the conditions of diverticulosis and its absence.

In each case of detection of diverticula it is necessary to solve the problem of the presence of an inflammatory process in them. The only reliable radiographic evidence of diverticulitis is a prolonged - 2 days or more - retention of suspension of barium sulfate in the cavity of diverticula. In this case, the presence of concrements in the urine and biliary tract, calcification of the pancreas, the presence of phlebolites in the abdominal cavity and small pelvis should be excluded. Other described radiologic signs of diverticulitis - uneven contours of the diverticulum, a display only of the bottom or only the cervix, a liquid with a horizontal level in the cavity of the diverticulum - are not reliable. The first two are often noted and with diverticulosis, the latter - rarely with diverticulitis. In the diagnosis of diverticulum of the colon, an x-ray study is important, in the detection of diverticulitis - a general clinical study of the patient.

Colonoscopy also allows you to detect diverticula, diagnose (in some cases) diverticulitis, to judge the condition of the mucous membrane of the colon. However, this study is contraindicated for elderly and senile patients.

In colonoscopy, the mouth of the diverticula is rounded or oval, sometimes closing and becoming slit-shaped. The cavity of diverticula often can not be inspected all the way, since it is usually larger than the size of the entrance to the diverticulum. Diverticula is often filled with contents, at times you can observe its entry into the lumen of the intestine. Endoscopic signs of diverticulitis are the deformity of the mouth of the diverticulum.

Colonoscopy can greatly help in the diagnosis of the source of intestinal bleeding. This method is particularly important in the differential diagnosis of inflammatory infiltrate and carcinoma, in the delimitation of diverticular disease from ulcerative colitis, Crohn's disease, ischemic colitis and other pathology of the colon.

Laboratory studies can identify diverticulitis. First of all, this increase in ESR, hyperleukocytosis. Coprological data confirm the presence of inflammation - the detection of neutrophils in the feces, impurities in the mucus of a large number of mononuclears, desquamated epithelium - less often.

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