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Small bowel diverticula: causes
Last reviewed: 23.04.2024
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The causes and pathogenesis of duodenal diverticula basically do not differ from those of other localization in the digestive tract. However, one should take into account, firstly, that with diseases such as peptic ulcer, dyskinesia of the duodenum, cholelithiasis (especially with frequent attacks of biliary colic), and other diseases of the digestive system, especially with the combination of several of them, the frequency of diverticulum of the duodenum significantly increases. Secondly, it also increases with age, especially after 60-70 years and older. The combination of these two main factors listed above also gives the highest frequency of detection of duodenal diverticula.
Most diverticulum of the duodenum is localized on its inner wall. In some cases, the onset of the diverticulum of the duodenum is facilitated by the presence of a foci (or foci) of heterotopia (inclusions into the intestinal wall) of pancreatic or adipose tissue. Relatively often, diverticula of the duodenum appear near the large papilla of the duodenum (Fater's nipple), which, when the diverticulum overflows with contents (with its narrow neck), and also with diverticulitis, creates the risk of compression of the distal part of the common bile and pancreatic ducts with the development of corresponding complications: in the duodenum, hyperbilirubinemia, jaundice of the subhepatic ("mechanical") type, cholangitis, pancreatitis, etc.
In the literature devoted to this issue, separate cases of the formation of "diverticulum in the diverticulum" (ie, the "daughter" diverticulum in the "maternal") are described.
Among the duodenal diverticula, besides the congenital and acquired, true and false, there are also the "functional" diverticula of the duodenum (and esophagus), which are determined only during radiographic examination with a suspension of barium sulphate - as temporary wall swelling during the passage of another portion of contrasting masses.
Dimensions of diverticulum of the duodenum are different: from a few millimeters in diameter to 6-8 cm or more.
Causes of development and pathogenesis of small intestine diverticula have not been fully elucidated. In some cases, they represent a congenital anomaly, developing in the weakest parts of the intestinal wall, in others - are acquired pathology. These are pulsion and tractional diverticula. Pulsatory diverticula arise with dyskinesia and spasms of the intestine, when areas of "relaxation" appear in adjacent areas with spasms, which leads to the swelling of the intestinal wall. With tractional diverticula, the intestinal wall is displaced ("pulled back") by a soldering process in the adhesive process, and a diverticulum is gradually formed. With multiple diverticula, their innate nature is more likely. The anatomical "weakness" of the intestinal wall is of undoubted importance in the origin of diverticula, as evidenced by their more frequent detection in older age groups, which are characterized by involuntary changes in connective tissue and muscular structures. Diverticula mainly localize on the side of the intestine, from which the mesentery departs, because in this area the muscular layer of the intestinal wall is thinner.
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