Sigmoid diverticulosis: causes, symptoms, treatment and complications
It belongs to the department. It can be inflamed due to the considerable curvature of this organ. As a result, there is considerable pressure on him, which leads to the formation of sigmoid diverticulosis. It manifests itself as the formation of protrusions. They are called diverticula.
The concept of "diverticulosis"
Diverticula form on the intestinal walls and resemble small sacs. Pathology can be congenital or acquired.
In congenital sigmoid diverticulosis, protrusions form in the child’s womb. Acquired disease can occur at any age with an unhealthy lifestyle, especially nutrition or the presence of pathology of the digestive system.
Diverticula may be from one to several. Such a disease as sigmoid diverticulosis is said in the latter case.
Sigmoid diverticulosis by ICD-10
In our country, the International Classification of Diseases (ICD) was introduced in 1999 to account for the causes of death, the reasons for individuals to apply to health facilities, and to report on morbidity. Currently, the ICD is the 10th revision. A new edition should be released by WHO in 2018.
The ICB sigmoid diverticulosis refers to diseases of the large intestine and has the code D57 "Diverticular bowel disease." If we look at the code in more detail, we can distinguish K57.2 and K57.3, which belong to the large intestine with and without perforation and abscess, respectively.
Diverticula in the large intestine are rare in people under 50 years of age (5%), the disease progresses after 50 to 70 years, its incidence increases to 30%, and after 70 to 50%. After 90 years, almost every person has multiple protrusions. They can be located in any part of the large intestine (sometimes they are also found in the small intestine), sigmoid diverticulosis is most often observed. This is due to its smaller diameter, compacted consistency of content, multiple bends. Also for the sigmoid colon is characterized by reservoir function, which increases the intraluminal pressure in it.The protrusions have a diameter of 3 mm to 3 cm or more.
Causes of illness
Sigmoid and descending colon diverticulosis is mainly caused by dystrophic changes in the intestinal walls, vascular dynamics and weakening of the connective tissue.
In addition, the reasons may be:
- chronic pathology.
The appearance of diverticula is strongly influenced by poor nutrition. The rational menu should include food with a slight saturation of carbohydrates and a large - fiber. In the opposite case, constipation. Hard stools begin to stretch the intestinal wall. However, the exact picture of what is happening is still not clear.
In addition, low physical activity and overweight affect the development of diverticulosis. At the same time, hemorrhoidal loss occurs during the formation of hemorrhoids, the development of constipation, which leads to the occurrence of the disease in question.
It occurs in residents of African and Asian countries is 10 times less than compared with Europeans and Americans.
In the presence of single protrusions, they do not manifest themselves for a long period of time.After the onset of the inflammatory process, the following symptoms of sigmoid colon diverticulosis appear:
- there are signs of severe intoxication;
- there are painful syndromes that are chronic;
- bleeding occurs;
- develop discomfort inside the abdomen.
The first painful syndromes begin to appear even before the onset of the inflammatory process. They are irregular, so they are mostly ignored by patients.
After the act of defecation and gas discharge, they pass.
At the beginning of the development of complications in the feces blood appears, which indicates trauma to the diverticulum. As the size of the protrusion increases, painful sensations appear that do not cease. During the implementation of palpation of the abdomen, they become more pronounced.
Symptoms of intoxication appear with long-term fecal mass in the sac and the beginning of the development of the inflammatory process.
The following symptoms appear:
- increase in body temperature.
Depending on the extent of the disease, various symptoms of sigmoid diverticulosis are observed.Treatment should be aimed at eliminating the cause of the disease. One person may simultaneously have several symptoms. They may develop as a result of the development of other pathologies that require an immediate emergency call to the house.
The main ones are the following:
- obstruction in the intestine due to the formation of adhesions, making it difficult for the feces to leave the body;
- perforation of the diverticulum, in which there is a rupture of the intestinal walls, because of which the fecal masses enter the abdominal cavity, intoxicating the body, causing acute abdominal pain, the gap alleviates suffering, but requires immediate hospitalization
- fistula formation - inflammatory processes can be purulent, which turn into fistulas when untreated, which are difficult to eliminate without surgery;
- severe bleeding - it is possible immediately after the onset of the inflammatory process, after the formation of sores on the diverticulum.
If a patient has severe abdominal pain, you should immediately visit a doctor or call an ambulance.
The doctor collects anamnesis, listening to the patient's complaints and carrying out palpation in the abdominal area. After that, an additional examination is appointed, including:
- blood test and feces;
- X-ray examination;
- Ultrasound of the abdominal organs.
An increase in the ESR and a leukocyte shift to the left are characteristic of diverticulitis. In the presence of bleeding, iron deficiency anemia is observed.
In addition to the diagnostic methods listed above, endoscopic examination may be prescribed. But in this case, the affected segment can be viewed. This is due to the fact that the mouths of the protrusions are detected if they are opened. They can also be skipped if the line of their location is in a blind zone.
Colonoscopy for severe inflammatory process is contraindicated.
In the acute stage of the disease, CT may be used.
After that, the doctor decides how to treat sigmoid diverticulosis.
If the pathology is in the initial stage of development without symptoms, then preventive measures and diet are prescribed to prevent constipation.The treatment of sigmoid diverticulosis in this case also envisages a set of exercises for the elimination of stool stagnation.
For more serious inflammatory processes, the following agents are prescribed:
- drugs from flatulence to reduce gas formation - "Smekta", "Espumizan";
- enzymatic means to normalize the function of digestion and reduce the load on the intestinal area;
- laxatives for the timely emptying of this body - "Fitomucil", "Mikrolaks", "Duphalac";
- prokinetics for the normalization of digestive motility and the provision of antibacterial, antidiarrheal and antiemetic actions - Ganaton, Motilak, Motilium;
- antispasmodics and painkillers for relieving spasms and eliminating pain syndromes: “No-shpa”, “Spazmalgon”, “Drotaverin”;
- drugs that restore the natural intestinal microflora: "Linex", "Bifiform", "Normobact";
- antibiotics - three courses for 5 days with repeat after 10 days: "Amoxiclav", "Azithromycin", "Sumamed".
With the development of serious complications, the patient is sent to hospitalization. With it, antibiotics are administered intravenously, which stops the development of inflammation.
When the sigmoid diverticulitis, perforation of the protrusion, the presence of multiple diverticulum or peritonitis is carried out surgery, which consists in removing the affected area. After a long period of recovery, the patient is prescribed antispasmodics, painkillers and laxatives.
In many cases, bleeding is stopped during the diagnosis of angiography by intra-arterial injection of “Vasopressin”. Sometimes it is stopped by surgery. At the same time, angiographic embolization can lead to intestinal infarction in every fifth patient, therefore, its implementation is not recommended. In most cases (in three-quarters of patients), the bleeding caused by the disease stops spontaneously.
Treatment of sigmoid diverticulosis involves taking one spoonful of olive or linseed oil in the morning after sleep, which helps to lighten the feces, saturate the body with minerals and vitamins, relieve inflammation in the intestines.
Also, to provide a carminative, anti-inflammatory and soothing effect take decoctions of the following plants:
- rose hips;
Also useful decoction of elderberry. They are poured boiling water and insist for several hours, after which they take 100 ml 3 times a day.
Diet for sigmoid diverticulosis
It is prescribed after stool normalization. The intestine should be periodically relaxed, therefore, the following foods and foods are included in the diet:
- porridge from oatmeal, buckwheat, brown rice;
- nuts and dried fruits - pumpkin seeds, walnuts, dried apricots, prunes;
- fruit and vegetable dishes: baked apricots, plums, pears, apples, boiled carrots, beets;
- drink plenty of water. Drinking per day you need at least 2 liters of liquid - dogrose infusion, green tea, tea drinks, mineral and filtered water.
Meal should be fractional, uniform. The number of receptions per day should be 5-6 times.
Nutrition for sigmoid diverticulosis does not include the following products in the diet:
- carbonated drinks;
- Black tea;
- coffee - the products listed above do not include for two to three months;
- fatty, fried foods;
- flour and sweet;
- delicatessen goods;
The latter worsen the digestive process and provoke chronic constipation. Meat dishes and seasonings lead to an increase in the load on the intestines, which leads to disruption of its work and irritates the mucous membrane.
In the case of development of diverticular bowel disease in most cases it is favorable. But in some cases, life-threatening severe complications may develop. This is mainly characteristic of older people who have weakened immunity and there are many associated diseases.
In the diet you need to enter foods rich in dietary fiber (fiber). In 5-10% of cases, this reduces the incidence of complications and improves the course of the disease.
One third of patients have recurrences of the inflammatory process. A fifth of them who have had bleeding problems see their return after a few months or years.
Acute diverticulitis may occur in a quarter of patients with diverticular disease. Conservative therapy in the first episode is effective in 70% of cases, in the third - in 6%.
The following activities should be undertaken:
- saturate the diet with dietary fiber;
- carry out massage;
- attend physical therapy classes.
Thus, sigmoid diverticulosis is ubiquitous after a person reaches 90 years of age. Up to 50 years, its prevalence is quite rare. The least common cases are found in Asian and African countries. Often it is asymptomatic, detected randomly in the diagnosis of associated diseases. In the absence of pain syndromes does not require treatment. At the same time in the diet should include foods rich in fiber. If pain syndromes are present, as well as bleeding, there is a need for medical intervention, which can be therapeutic or surgical. In the complex treatment can be used folk remedies in the form of decoctions of various herbs.