Diverticulitis of the sigmoid colon, Symptoms and Treatment

Diverticulosis of the sigmoid colon is called one of the chronic diseases of the intestine, namely the sigmoid. It manifests itself in the form of saccular hernia - a diverticulum formed on the intestinal walls.

The disease occurs in one out of ten people who have reached the age of forty. She quickly becomes chronic and seventy years of diverticulosis can be found in half the population.

It is worth noting that the most prevalent disease was in countries where the diet is the basis for products of animal origin. In countries with traditional vegetarianism percentage of cases is much lower.

What it is?

Diverticulosis sigmoid colon - is a pathological process that occurs in the colon, accompanied by advent plurality of diverticula which are baggy protrusions (diverticula sigmoid intestine).

Causes

As you already know, diverticula have a lot of people, but only 10-20% of them starts diverticulitis. Now we try to understand what causes provoke inflammation.

1. Inflammation of the colon. The cause of diverticulitis can be: ulcerous, spasmodic or ischemic colitis, infectious enterocolitis, intestinal infections. These diseases cause inflammation of the intestinal mucosa. If you can pretty quickly cope with the bacteria that caused the disease, the diverticula they continue to multiply in the intestinal lumen. A weakened local immunity and the violation of the microflora in the gut contribute to the development of diverticulitis.
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2. Poor fiber foods, causing constipation. If you eat less than 30 grams of fiber (dietary fiber), then you are at risk. Note that most of our fellow citizens receive only half the norm. In this case, slowing movement of food through the gastrointestinal tract. The contents of the bowel becomes more dry and hard, and stuck in the colon cells - develop constipation. Intestine greatly compresses the stool, and the pressure rises strongly. This leads to blockage and inflammation of diverticula.
3. Hereditary predisposition. Inherited from their parents characteristics are transmitted intestinal structure and the weakness of its connective tissue. In this case, the child is born with diverticula or they appear at an early age and are often multiple. When dysbacteriosis or lowering of immunity after infection of intestinal diverticula inflamed.
4. Age. With age decreases the tone of muscles, impaired intestinal motility and constipation occur. The mucous membrane of the intestine becomes thinner and weaker immunity. The elderly often diverticula form worse cleaned and therefore more likely to become inflamed.
5. Infestation with intestinal worms. Helminths living in the intestine, mucosal damage, break microflora and reduce its protection against bacteria. Under such conditions, they multiply rapidly harmful bacteria that like to settle on the coated surface erosion diverticulum.

The disease has no specific symptoms, which would be the doctor could say unequivocally: "That you have diverticulitis!". The disease is often mistaken for appendicitis, gynecological disease or renal colic.

types of diseases

Diverticular disease is classified according to the following steps.

1. Acute diverticulosis. Characterized manifestations spasms intestinal wall, failure digestion and intestinal environment.
2. Asymptomatic diverticulosis. Patients no clinical manifestations of the disease. Diverticula are found in the diagnosis of other pathologies.
3. Complicated diverticulosis. It requires emergency care.

Complicated diverticular disease is classified into the following categories.

1. Perienteric infiltrate. It occurs as a result of inflammation in the peritoneal cavity, Break diverticular wall.
2. Diverticulitis. Develops due to the concentration of feces in diverticula that promotes growth of bacteria and infection.
3. Intestinal fistula. With the opening of an abscess on the skin of the abdominal wall or adjacent organ, as a result of festering there are internal and external fistulas, which require surgical intervention.
4. Perforation of the diverticulum. In the case of the perforation into the abdominal cavity, peritonitis occurs in the mesentery of the sigmoid colon - retroperitoneal abscess.
5. Intestinal bleeding. Mucosal damage solid stool leads to damage of blood vessels and the plurality of blood loss during defecation and separately.

Diverticular disease shared by both true and false. The true form is congenital in nature and is caused by protrusion of all sectors of the colon. False form of diverticular disease is acquired and developed in the course of life and is characterized by protrusion of the mucosa.

Also share a single and multiple diverticula of the sigmoid colon. Configuration diverticulum is quite diverse: pear-shaped, spherical, oval, etc. The size of the holes and they are also different. The smaller the width of the opening, the greater the probability of the formation and accumulation of feces in the diverticulum stones and the formation of the inflammatory process.

Symptoms of inflammation of the sigmoid colon

Diverticulitis of the sigmoid colon is characterized by a hidden passage. In some patients the symptoms appear very bright, even accompanied by cramping pains. Diverticulosis sigmoid colon at the stage of inflammation has other symptoms:

• bloating with a bias to the left side;
• aching pain on the lower left with respect to the abdomen;
• unstable chair with frequent constipation;
• heaviness in the abdomen, passing only after a bowel movement;
• with more severe - nausea and vomiting;
• the presence of blood in the stool;
• heat;
• general malaise.

Diverticulosis may be accompanied by almost any intestinal manifestations, depending on the characteristics of the disease. Thus, it may occur constipation, and diarrhea, and abdominal pain, and bloating. The pain can last from several minutes to several days.

Since most of diverticula do not cause any symptoms, when they occur indicate symptomatic diverticulosis. Any manifestations of the disease already indicate the presence of complications and require immediate treatment. Some of these symptoms may be caused by other diseases and pathological conditions, such as appendicitis, colic. They can be life-threatening, like himself, diverticulitis, so to delay medical help is not necessary.

If you notice such symptoms should consult a physician or surgeon. Doctor will prescribe further tests: ultrasound, X-ray colon, colonoscopy, blood tests, etc.

complications

Progression of the disease is fraught with abscess, and the abscess may burst into the peritoneal cavity. Symptoms subsided in all cases lead to the final resolution of infiltrates, then case there is hardening of the mesentery and the surrounding tissue that may end Abdominal tumor cavity.

Repeated bouts of diverticulitis can lead to bowel adhesions with neighboring organs. There is already an abscess has the ability to be opened in the bladder, vagina, urethra, small intestine, and the formed fistula. However, perforation of the sigmoid colon diverticulum is free in the abdominal cavity can be quite tragic consequences, because it develops and progresses rapidly peritonitis.

Intestinal bleeding in this disease can not be considered abundant, but it is so pronounced that it was quickly noticed and the patient and the doctors. Hidden its form, usually appear in anemia. As to recognize the cause of all these symptoms is difficult, complex research use. In addition to the clinical manifestations of the disease, are taken into account and the results are indispensable radiographic and endoscopic studies.

Diagnostics

The diagnosis of diverticulosis of the sigmoid colon involves uncomplicated course and the absence of symptoms inflammatory process, therefore for a detailed study of the disease used tools methods.

First of all, this is a blood test and stool. The data obtained are quite informative. For suspected diverticulitis colonoscopy is appointed. It allows you to visually inspect the condition of the intestinal mucosa, but also provides an opportunity to take a tissue sample for analysis. The device is a flexible tube with a fixed cam that is inserted in the anus. The image is transmitted to the monitor.

1. Barium enema. For more detailed information, the sigmoid colon and accurate detection diverticula apply double contrast method: The patient drinks the mixture barium, and further it is introduced into the air lumen of the intestine that extends formation, and further it radiopaque substance contoured. On the resulting radiographs are presented in the form of protrusions, a certain shape, with a neck that connects with the lumen of the gut. The method allows to determine the number, type and localization of diverticula.
2. In recent years, mostly carried ultrasound. It gives an overview of the state of the sigmoid colon. This method is the safest and painless. However, it can detect only pronounced diverticula, so some experts prescribe ultrasound as an additional study.

When used exacerbation laparoscopy. This is both a diagnosis and treatment. During its passage 3 made incision through which is introduced into the peritoneal cavity of a high resolution camera. It allows any changes fix the outer surface of the intestine. If necessary, the diverticulum immediately removed by the surgeon. This procedure is performed using general anesthesia.

diverticulitis treatment

In the case of treatment of diverticulitis of the sigmoid colon scheme will depend on many factors: the step disease, the risk of complications, the patient's age and general state of health, his life-style and features power. Uncomplicated diverticulosis treated conservatively, severe forms of the disease therapy involves surgery.

1. If the diverticula are inflamed, but the risk of complications is minimal, it is assigned a course of antibiotics. Treatment with antibiotics is always accompanied by a special diet and taking probiotics.
2. If the diverticulum was discovered by chance, it is not inflamed and does not manifest itself, the treatment is only in the prevention of constipation, diet correction.
3. In cases of serious and complicated course of the disease the patient is hospitalized. Antibiotics are administered intravenously.
4. Surgery is assigned only in extreme cases when the risk of serious complications, diverticula break and peritonitis. In this case, remove the affected part of the bowel.

Conservative treatment includes complex approach, including special diet therapy and medical drugs. The patient is prescribed:

1. Analgesics and antispasmodics, reducing muscle spasm (drotaverin, no-spa, mebeverine);
2. Antibiotics possessing broad spectrum of activity (cephalosporins, penicillins);
3. Laxatives based lactulose (Duphalac);
4. Prokinetics, stimulating bowel motility;
5. Drugs that restore the intestinal microflora (Linex, bifidumbacterin);
6. Enzymes for digestion (mezim, pancreatin, Festalum);
7. Means to get rid of diarrhea and flatulence (Biseptol, sulgin).

In severe forms of diverticulosis carry out the following remedial measures:

1. Unload intestine via siphon enemas;
2. Make gastric lavage;
3. Carry infusion therapy crystalloid solutions;
4. Apply fresh frozen plasma.

Surgery

The reason for the surgery, there are two types of indications - and emergency planning.

To emergency include:

• perforation of the diverticulum;
• profuse bleeding;
• ileus.

Of the planned include:

• no result from conservative methods of treatment of the disease;
• the presence of a fistula;
• the formation of a chronic infiltration.

In most cases, instead of severe abdominal surgery intervention performed laparoscopically. Instead of a large long healing seam in the skin of the abdomen are several punctures and a small incision to extract a remote part of the intestine. This allows you to subscribe to patients without complications for 3-5 hours.

Folk remedies

We recommend the following folk remedies that promote the normalization of stool and restore bowel function:

1. Powder from carrot seed (you need to grind the carrot seeds carefully and use the powder several times a day (2-3), drinking plenty of water - 200-300 ml).
2. The brine pickled cabbage or radish juice (drink a few tablespoons after meals 1-2 times a day).
3. Infusion of aloe leaves (approximately 150 g of crushed leaves pour 300 g of honey, the resulting mixture infuse 24 hours, filter and take tablespoon hour before meals).
4. Linseed oil 1 tablespoon daily on an empty stomach.
5. Mint tea (add 2-3 mint leaf in a conventional tea).

Diet for Disease

Diet should correspond to the needs of a patient's body in calories, and the amount of food consumed at one time, not to exceed 200 ml. The multiplicity of methods of food 6-7 times a day, in order to avoid a small amount of food mass in the intestine.

When diverticulosis of the sigmoid colon is recommended:

• lean meat (chicken, beef, rabbit, turkey) and all kinds of fish;
• eat food with a high level of fiber (raw fruits and vegetables, cereals, hard varieties of pasta and bran);
• eliminate from your diet shopping cakes, flour products, made on the basis of a shiver, sweets, smoked, salty and spicy food, as well as legumes, strong tea and coffee, alcoholic beverages;
• morning obligatory fasting to take a tablespoon of flaxseed oil, which prevents the development of constipation and reduces inflammation in the intestines.

It is strictly prohibited to fast food.

Prediction and prevention

Avoid the formation of diverticula of the sigmoid colon may be adhering to proper nutrition: it disease practically does not occur in countries where people eat mostly vegetables, fruits and cereals. Diet should consist of foods rich in fiber. The first step is porridge (oats, buckwheat, wheat), fruits, raw and steamed vegetables. You should also pay more attention to moderate exercise.

Due to the fact that 80% of patients diverticula of the sigmoid colon are asymptomatic, the prognosis of this disease is quite favorable. He gets worse with age, since the start progressing atrophic changes in the walls of the intestine. Less favorable prognosis of complications such as abscess, peritonitis, perforation of the diverticula of the sigmoid colon.