Bleeding diverticulitis symptoms: Symptoms & Causes of Diverticular Disease
Symptoms & Causes of Diverticular Disease
In this section:
What are the symptoms of diverticulosis?
Most people with diverticulosis do not have symptoms. If your diverticulosis causes symptoms, they may include
Other conditions, such as irritable bowel syndrome and peptic ulcers, cause similar symptoms, so these symptoms may not mean you have diverticulosis. If you have these symptoms, see your doctor.
If you have symptoms such as bloating, constipation or diarrhea, or pain in your lower abdomen, see your doctor.
If you have diverticulosis and develop diverticular bleeding or diverticulitis, these conditions also cause symptoms.
What are the symptoms of diverticular bleeding?
In most cases, when you have diverticular bleeding, you will suddenly have a large amount of red or maroon-colored blood in your stool.
Diverticular bleeding may also cause dizziness or light-headedness, or weakness. See your doctor right away if you have any of these symptoms.
What are the symptoms of diverticulitis?
When you have diverticulitis, the inflamed pouches most often cause pain in the lower left side of your abdomen. The pain is usually severe and comes on suddenly, though it can also be mild and get worse over several days. The intensity of the pain can change over time.
Diverticulitis may also cause
What causes diverticulosis and diverticulitis?
Experts are not sure what causes diverticulosis and diverticulitis. Researchers are studying several factors that may play a role in causing these conditions.
For more than 50 years, experts thought that following a low-fiber diet led to diverticulosis. However, recent research has found that a low-fiber diet may not play a role. This study also found that a high-fiber diet with more frequent bowel movements may be linked with a greater chance of having diverticulosis.4 Talk with your doctor about how much fiber you should include in your diet.
Some studies suggest that genes may make some people more likely to develop diverticulosis and diverticulitis. Experts are still studying the role genes play in causing these conditions.
Studies have found links between diverticular disease—diverticulosis that causes symptoms or problems such as diverticular bleeding or diverticulitis—and the following factors:
Diverticulitis may begin when bacteria or stool get caught in a pouch in your colon. A decrease in healthy bacteria and an increase in disease-causing bacteria in your colon may also lead to diverticulitis.
 Peery AF, Barrett PR, Park D, et al. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology. 2012;142(2):266–272.
Diverticular Disease & Bleeding: Causes, Symptoms, and Treatments
Diverticular disease consists of three conditions that involve the development of small sacs or pockets in the wall of the colon, including diverticulosis, diverticular bleeding, and diverticulitis.
Diverticulosis is the formation of numerous tiny pockets, or diverticula, in the lining of the bowel. Diverticula, which can range from pea-size to much larger, are formed by increased pressure on weakened spots of the intestinal walls by gas, waste, or liquid. Diverticula can form while straining during a bowel movement, such as with constipation. They are most common in the lower portion of the large intestine (called the sigmoid colon).
Diverticulosis is very common and occurs in 10% of people over age 40 and in 50% of people over age 60. Most people will have no or few symptoms from diverticula.
Complications can occur in about 20% of people with diverticulosis. One of these complications is rectal bleeding, called diverticular bleeding, and another is diverticular infection, called diverticulitis.
Diverticular bleeding occurs with chronic injury to the small blood vessels that are next to the diverticula.
Diverticulitis occurs when there is inflammation and infection in one or more diverticula. This usually happens when outpouchings become blocked with waste, allowing bacteria to build up, causing infection.
What Are the Symptoms of Diverticulosis?
Diverticulosis does not cause any troublesome symptoms.
What Are the Symptoms of Diverticulitis?
Diverticulitis, infection and inflammation of diverticula, can occur suddenly and without warning.
Symptoms of diverticulitis may include:
How Is Diverticulosis Diagnosed?
Because people with diverticulosis do not have any symptoms, it is usually found through tests ordered for an unrelated reason. They usually include barium enema, sigmoidoscopy and colonoscopy.
How Is Diverticulitis Diagnosed?
If you are experiencing the symptoms of diverticulitis, it is important to see your doctor.
Your doctor will ask questions about your medical history (such as bowel habits, symptoms, diet, and current medications) and perform a physical exam, possibly including an abdominal exam.
One or more diagnostic tests may be ordered. Tests usually include blood tests and CT scanning.
In people with rapid, heavy rectal bleeding, the doctor may order a colonoscopy to locate the source of bleeding.
How Is Diverticulosis Treated?
People who have diverticulosis without symptoms or complications do not need specific treatment, yet it is important to adopt a high-fiber diet to prevent the further formation of diverticula.
Laxatives should not be used to treat diverticulosis and enemas should also be avoided or used infrequently.
What Are the Complications of Diverticulitis?
Serious complications can occur as a result of diverticulitis. Most of them are the result of the development of a tear or perforation of the intestinal wall. If this occurs, intestinal waste material can leak out of the intestines and into the surrounding abdominal cavity causing the following problems:
- Peritonitis (a painful infection of the abdominal cavity)
- Abscesses (“walled off” infections in the abdomen)
- Obstruction (blockages of the intestine)
If an abscess is present, the doctor will need to drain the fluid by inserting a needle into the infected area. Sometimes surgery is needed to clean the abscess and remove part of the colon. If the infection spreads into the abdominal cavity (peritonitis), surgery is needed to clean the cavity and remove the damaged part of the colon. Without proper treatment, peritonitis can be fatal.
Infection can lead to scarring of the colon, and the scar tissue may cause a partial or complete blockage. A partial blockage does not require emergency surgery. However, surgery is required with complete blockage.
Another complication of diverticulitis is the formation of a fistula. A fistula is an abnormal connection between two organs, or between an organ and the skin. A common type of fistula is between the bladder and colon. This requires surgery to remove the fistula and affected part of the colon.
How Can Diverticulosis Be Prevented?
To prevent diverticular disease or reduce the complications from it, maintain good bowel habits. Have regular bowel movements and avoid constipation and straining. Eating appropriate amounts of the right types of fiber and drinking plenty of water and exercising regularly will help keep bowels regulated.
The American Dietetic Association recommends 20 to 35 grams of fiber a day. Every person, regardless of the presence of diverticula, should try to consume this much fiber every day. Fiber is the indigestible part of plant foods. High-fiber foods include whole grain breads, cereals, and crackers; berries; fruit; vegetables, such as broccoli, cabbage, spinach, carrots, asparagus, squash, and beans; brown rice; bran products; and cooked dried peas and beans, among other foods.
ASGE | Understanding Diverticulosis
What is diverticulosis?
Diverticulosis is a condition in which there are small pouches or pockets in the wall or lining of any portion of the digestive tract. These pockets occur when the inner layer of the digestive tract pushes through weak spots in the outer layer. A single pouch is called a diverticulum. The pouches associated with diverticulosis are most often located in the lower part of the large intestine (the colon). Some people may have only several small pouches on the left side of the colon, while others may have involvement in most of the colon.
Who gets diverticulosis?
Diverticulosis is a common condition in the United States that affects half of all people over 60 years of age and nearly everyone by the age of 80. As a person gets older, the pouches in the digestive tract become more prominent. Diverticulosis is unusual in people under 40 years of age. In addition, it is uncommon in certain parts of the world, such as Asia and Africa.
What causes diverticulosis?
Because diverticulosis is uncommon in regions of the world where diets are high in fiber and rich in grains, fruits and vegetables, most doctors believe this condition is due in part to a diet low in fiber. A low-fiber diet leads to constipation, which increases pressure within the digestive tract with straining during bowel movements. The combination of pressure and straining over many years likely leads to diverticulosis.
What are the symptoms of diverticulosis?
Most people who have diverticulosis are unaware that they have the condition because it usually does not cause symptoms. It is possible that some people with diverticulosis experience bloating, abdominal cramps, or constipation due to difficulty in stool passage through the affected region of the colon.
How is the diagnosis of diverticulosis made?
Because most people do not have symptoms, diverticulosis is often found incidentally during evaluation for another condition or during a screening exam for polyps. Gastroenterologists can directly visualize the diverticula (more than one pouch, or diverticulum) in the colon during a procedure that uses a small camera attached to a lighted, flexible tube inserted through the rectum. One of these procedures is a sigmoidoscopy, which uses a short tube to examine only the rectum and lower part of the colon. A colonoscopy uses a longer tube to examine the entire colon. Diverticulosis can also be seen by other imaging tests, for example, computed tomography (CT) scan or barium x-rays.
What is the treatment for diverticulosis?
Once diverticula form, they do not disappear by themselves. Fortunately, most patients with diverticulosis do not have symptoms, and therefore do not need treatment. When diverticulosis is accompanied by abdominal pain, bloating or constipation, your doctor may recommend a high-fiber diet to help make stools softer and easier to pass. While it is recommended that we consume 20 to 35 grams of fiber daily, most people only get about half that amount. The easiest way to increase fiber intake is to eat more fruits, vegetables or grains. Apples, pears, broccoli, carrots, squash, baked beans, kidney beans, and lima beans are a few examples of high-fiber foods. As an alternative, your doctor may recommend a supplemental fiber product such as psyllium, methylcellulose or polycarbophil. These products come in various forms including pills, powders, and wafers. Supplemental fiber products help to bulk up and soften stool, which makes bowel movements easier to pass. Your doctor may also prescribe medications to help relax spasms in the colon that cause abdominal cramping or discomfort.
Are there complications from diverticulosis?
Diverticulosis may lead to several complications including inflammation, infection, bleeding or intestinal blockage. Fortunately, diverticulosis does not lead to cancer.
Diverticulitis occurs when the pouches become infected or inflamed. This condition usually produces localized abdominal pain, tenderness to touch and fever. A person with diverticulitis may also experience nausea, vomiting, shaking, chills or constipation.
Your doctor may order a CT scan to confirm a diagnosis of diverticulitis. Minor cases of infection are usually treated with oral antibiotics and do not require admission to the hospital. If left untreated, diverticulitis may lead to a collection of pus (called an abscess) outside the colon wall or a generalized infection in the lining of the abdominal cavity, a condition referred to as peritonitis. Usually a CT scan is required to diagnose an abscess, and treatment usually requires a hospital stay, antibiotics administered through a vein and possibly drainage of the abscess.
Repeated attacks of diverticulitis may require surgery to remove the affected portion of the colon. Bleeding in the colon may occur from a diverticulum and is called diverticular bleeding. This is the most common cause of major colonic bleeding in patients over 40 years old and is usually noticed as passage of red or maroon blood through the rectum.
Most diverticular bleeding stops on its own; however, if it does not, a colonoscopy may be required for evaluation. If bleeding is severe or persists, a hospital stay is usually required to administer intravenous fluids or possibly blood transfusions. In addition, a colonoscopy may be required to determine the cause of bleeding and to treat the bleeding. Occasionally, surgery or other procedures may be necessary to stop bleeding that cannot be stopped by other methods. Intestinal blockage may occur in the colon from repeated attacks of diverticulitis. In this case, surgery may be necessary to remove the involved area of the colon.
This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.
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What is Diverticulosis & Diverticulitis? – PA GI
What Causes Diverticulosis?
The exact cause of diverticulosis is unknown. Doctors believe a low fiber, processed food diet may be one of the main causes of diverticulosis. Contrary to popular belief, the consumption of nuts, seeds, and kernel products are not associated with an increased risk of diverticulitis.
What Is Diverticulitis?
Inflammation or infection of a diverticulum may lead to diverticulitis. Diverticulitis is characterized by fever and abdominal pain, usually in the left lower abdomen. Other symptoms include nausea, vomiting, constipation, diarrhea, and rarely urinary discomfort. Recent data suggests that the lifetime risk of developing diverticulitis is lower than previously quoted. Current estimates suggest that the risks of developing diverticulitis may be between 4 and 10 percent.
Complications Of Diverticulosis And Diverticulitis?
Diverticulitis can lead to complications such as infection, abscesses, perforation obstruction.
Rarely diverticulitis infections can cause a fistula or connection to develop between inflamed colon and contiguous organs such as the small bowel or bladder.
Diverticulosis may cause intestinal bleeding. This bleeding is usually painless, and results in maroon or bright red blood from the rectum.
Treatment Of Diverticular Disease
For many years, patients with diverticulosis were advised to avoid foods that may leave coarse particulate matter in stool such as nuts, seeds, corn, and kernel products. This recommendation was based on the theory that these particles could potentially obstruct diverticula and lead to diverticulitis or diverticular bleeding. A research study from 1997 suggested that dietary nuts, seeds, corn, and kernel products were not associated with an increased risk of diverticulitis or diverticular bleeding. A study from 2011 suggested that a high-fiber diet may help protect against development of diverticula. Fiber may be helpful by reducing the pressure in the colon of patients with diverticulosis. Fiber consumption of 20—35 grams a day is advised.
Treatment of diverticulitis varies depending on the severity.
Mild uncomplicated diverticulitis may be treated as an outpatient with antibiotics, bowel rest, and close observation. Medication including antispasmodics may also be used to relieve pain.
More severe cases of diverticulitis require hospitalization for intravenous (IV) antibiotics. In some cases abscess drainage or surgery to remove the diseased portion of colon may be necessary.
Most diverticular bleeding is self-limited, and resolves without complications. Some patients require hospitalization for IV fluids, close monitoring and possibly blood transfusion.
Occasionally, patients may require additional treatment to stop a bleeding diverticulum, including colonoscopy, angiography, or surgery.
Diverticulitis – Causes, Symptoms, Treatment, Diagnosis
Diverticula are sacs formed by a fold of the lining of the intestinal wall. They project from within the bowel through the muscle surrounding the bowel, and may occasionally trap feces moving through the intestine. Diverticula are extremely common and usually harmless. They often appear in bunches. Each is typically less than an inch in diameter. They tend to appear after age 40 and are more likely to appear in seniors.
Diverticulosis is the condition of having one or more diverticula. Usually there are no symptoms or problems associated with this condition, yet it is present in 75% of people over 80 years old.
Occasionally, diverticula become inflamed. If you have one or more inflamed diverticula, you are diagnosed with diverticulitis. The word ending “-itis” means inflammation. Diverticulitis can be a serious condition.
Diverticula can also appear in the gastrointestinal tract above the stomach, in the esophagus. In these cases, it’s food rather than feces that may get trapped. Esophageal diverticula don’t cause dangerous problems, but a few people find that trapped food comes back up when they bend over or lie down.
It’s believed that most diverticula are caused by unnoticed muscle spasms, or by pairs of muscles that don’t contract in a synchronized manner. This puts brief but intense pressure on the mucosal layer of your intestine, pushing it through the weakest points of the intestinal wall, leading to the formation of diverticula. The weakest points are the areas around blood vessels that pass through the inside of the wall of the large intestine (also called the colon). Older people have frailer tissue lining the bowel – this is probably why they have more diverticula.
Factors which may increase your chance of developing diverticula include a low-fibre diet and lack of exercise. Being overweight and smoking can also increase the risk of developing diverticulitis.
Symptoms and Complications
Diverticulosis is unnoticeable if there are no complications. Most people live their whole lives without their diverticula ever becoming noticeable.
Bleeding and inflammation are two possible complications of diverticulosis.
Bleeding can result if feces get lodged in a diverticulum. The bowel draws fluid out of feces before ejecting it. If it stays there a long time, it becomes dry and hard. It can erode nearby blood vessels. Though this process is usually painless, occasionally a large amount of bright red blood comes out of the rectum. Medications, like anti-inflammatories and opioids, can also increase your risk of bleeding from diverticula. If heavy bleeding continues, it’s an emergency requiring immediate hospital treatment. If a very small amount leaks out continually, it can still add up over time and cause mild anemia. Bleeding that doesn’t stop always requires treatment.
The other potential problem caused by diverticula is inflammation – in other words, diverticulitis. Unlike bleeding diverticula, inflamed and infected diverticula can become extremely painful and tender.
Sudden pain is particularly bad in the lower left abdomen, as most diverticula occur in the left side of the bowel. Pressing this area gently will make the discomfort worse. You may also experience nausea and vomiting, changes in bowel habits, and potential difficulty or pain while passing urine. You might also run a fever. If these symptoms occur, you should seek medical attention.
Diverticulitis can range from being mildly uncomfortable to dangerous. It depends on the amount of inflammation in the bowels and if it has spread to other areas. A fistula is a tunneling inflammation that eats its way from one organ to another. Organs near the bowel (e.g., the bladder, uterus, and vagina) can be affected. If the inflammation eats through the bowel wall or if the bowels are perforated, stool can spill into the abdominal cavity. The resulting infection and inflammation creates a serious situation known as peritonitis. Peritonitis is the name used when large parts of the abdominal cavity are inflamed. People with peritonitis always have a fever, and the belly often feels hard and bloated. Untreated, peritonitis causes death in a few hours or days.
Making the Diagnosis
Often your doctor may find that you have diverticulosis when performing a test looking for a different disease. For example, during a routine colonoscopy your doctor may see the diverticula.
During an attack, your doctor will do a physical exam and ask you about symptoms. They may also run blood, urine, and other tests to check for infection and rule out other possible causes. A computer axial tomography (CAT) scan, also known as a CT scan, is used to confirm a diagnosis of diverticulitis.
Treatment and Prevention
The great majority of people with diverticulosis never experience mild bleeding, let alone fistulas or peritonitis.
If you have diverticula, your doctor may want to minimize their number to avert the possibility of diverticulitis. Medications don’t usually help, but a high-roughage diet and sometimes bran or psyllium seed preparations can help.
Esophageal diverticula are normally left in place, as they pose no danger.
Bleeding from a diverticula may stop after the administration of medications such as vasopressin.* Sometimes, a doctor can stop the bleeding during a colonoscopy. If the bleeding does not stop, you may need a segmental resection, which is a surgical procedure to remove part of an organ (in this case, part of the intestines).
Many times, surgery can be performed laparoscopically, which is a less invasive surgery performed through very small incisions in the abdomen using a very specialized surgical instrument.
Mild diverticulitis can be treated at home with rest, a modified diet, and antibiotics. You’ll often feel better within a week, though it’s still important to follow your doctor’s instructions regarding diet for a few weeks after that. People with severe diverticulitis are treated in hospital. They’re fed by intravenous drip to keep the gastrointestinal tract rested and empty, and if necessary given intravenous antibiotics.
If you have repeated attacks of diverticulitis, your doctor may consider you as a candidate for surgery. Again, the standard procedure is segmental resection. This operation doesn’t cause incontinence or any loss of bowel function.
If peritonitis or other complications of the rupture of the bowel wall occur, surgery is needed to close the hole and/or drain the infection.
To prevent or slow the development of diverticula and diverticulitis, do the following to help promote a healthy bowel:
- Increase the amount of fibre in your diet – eat high-fibre foods such as whole grains, fruits, and vegetables.
- Drink lots of water throughout the day.
- Exercise regularly.
All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Diverticulitis
Diverticulitis Treatment Sugar Land | Diverticular Bleeding Humble
What is Diverticular Disease?
The intestine is divided into the large and small intestine. The large intestine absorbs nutrients from the food that you eat and pushes the remaining undigested waste towards the anus. High fibrous foods like fruits and vegetables soften the undigested material and help in easy movement of stools. However, low-fiber foods can produce small and hard stools that are expelled with increased strain while passing. This straining can create weak spots in the wall of the intestine leading to diverticular diseases, conditions that cause the development of small sacs or pouches. The conditions include diverticulosis, diverticular bleeding, and diverticulitis.
Inflammation and infection of the diverticula is known as diverticulitis. When waste material blocks the diverticula, they can become inflamed due to bacterial invasion. Increased pressure on the colon wall or a block at the entrance of the diverticula can reduce blood supply and lead to infection and inflammation.
Diverticulosis is a condition where a large number of small pouches, known as diverticula, develop in the lining of the bowel. They can be small or large and are formed with increased strain during bowel movements, or when gas, waste, or liquid put pressure on the weak portions of the walls of the intestine. This is a common condition that can be found in 10% of people above age 40 and 50% of people over the age of 60.
Diverticular bleeding occurs when there is an injury to the blood vessels lying adjacent to the diverticula.
What are the Signs & Symptoms of Diverticular Disease?
People suffering from diverticulosis do not have any serious symptoms, but when infection or inflammation occurs, the condition is known as diverticulitis and symptoms can be sudden in onset. The common symptoms include:
- Abdominal pain and tenderness in the left lower abdomen
- Pain worsens while eating and relieves after flatulence or passing stools
- Alternating episodes of constipation and diarrhea
- Bleeding from the rectum
- Abdominal bloating
- Alternating diarrhea with constipation
- Nausea and vomiting
- Fever and chills
Diverticular diseases can lead to other complications:
- Peritonitis: rupture of diverticula and leakage of intestinal contents into abdominal cavity
- Blockage in colon or small intestine due to scarring
- Abscess formed by collection of pus
- Fistula: abnormal passage between intestine and abdominal wall or intestine and bladder or vagina
What are the methods of Screening and Diagnosis of Diverticular Disease?
As people with diverticulosis show no symptoms, diagnosis usually occurs during routine screening examinations such as colorectal cancer screening or other intestinal tests.
When you present with symptoms of diverticulitis, your doctor will examine your medical history with relation to your diet, bowel habits, and current medications used, and will perform a physical examination. He/she may also conduct a digital rectal examination, where a gloved and lubricated finger will be inserted into your rectum to check for abnormalities. You may be recommended the following diagnostic tests in order to determine the extent of damage to your intestine:
- Imaging tests like X-rays, ultrasound and CT scans
- Sigmoidoscopy: A flexible tube with a camera fitted at one end (sigmoidoscope) is introduced through the anus to visualize the inner lining of the sigmoid colon (lower 1/3rd of the colon) and rectum.
- Colonoscopy: A flexible tube with a camera fitted at one end (colonoscope) is introduced through the anus to visualize the entire large intestine.
- Blood tests: A sample of your blood is analyzed in the laboratory for infection.
You may also be recommended to undergo angiography to identify the site of bleeding if you have heavy rectal bleeding. Angiography is a procedure performed to visualize blood vessels after injecting a contrast material into the arteries.
What are the Treatment Options for Diverticular Disease?
Treatment for diverticular diseases depends on the severity of symptoms. People showing no symptoms of diverticular diseases are recommended a high-fiber diet to avoid constipation and increased stress on the colonic wall. Your doctor may prescribe medication for pain and antibiotics for infections.
In patients with recurrent episodes of diverticulitis, leading to complications such as abscess, perforation, or fistula, surgical treatment may be recommended. Surgery involves removing the diseased portion of your colon. There are two types of surgery:
- Primary Bowel Resection
During this procedure, the affected portion of your intestine is removed and the healthy ends are reattached using a procedure known as anastomosis. Depending on the extent of damage to your intestine, primary bowel resection can be performed laparoscopically or using an open surgery technique. During an open surgery, your surgeon will create one long abdominal incision, while a laparoscopic procedure can be performed through 3 or 4 small incisions. The recovery process is usually faster with laparoscopic surgery. The advantage of primary bowel resection is that you will be able to have normal bowel movements after the surgery.
- Bowel Resection with Colostomy
When you have severe inflammation in your intestine, making it difficult to re-join your colon to your rectum, your doctor may perform bowel resection with colostomy. During a colostomy, your doctor will create a surgical opening (stoma) in your abdominal wall and join the healthy part of your colon to the stoma. Waste from the colon flows through the stoma into a collecting bag (colostomy bag) attached to the stoma. Your surgeon may be able to perform another surgery to re-join your colon and rectum once the inflammation has healed.
90,000 Diverticular disease, colon diverticulosis
Diverticular disease – a disease characterized by clinical manifestations of varying severity due to the presence of diverticulum or diverticulosis, including inflammation (diverticulitis) and its complications (peridiverticulitis, abscess, perforation, fistula, peritonitis), as well as bleeding.
Diverticular disease predominantly affects the sigmoid colon, then the descending colon, less often the right half of the transverse colon, and rarely the right colon.
Until now, it is not known which of the factors is more important for the development of diverticula: anatomical defect of the intestinal wall or the action of forces in the intestinal cavity.
Found that the basal intracavitary pressure in patients with diverticular disease and in healthy individuals is the same. However, the segment of the intestine affected by diverticula contracts more strongly in response to food intake or pharmacological stimuli.
Another important etiological factor may be the weakness of the intestinal wall.The muscle tone of the large intestine gradually decreases with age, which, apparently, explains the predominant lesion of the elderly.
Thus, diverticular disease can be explained by a periodic significant increase in intracavitary pressure, affecting the wall of the colon weakened by age-related changes.
This disease is classified as follows:
- Diverticular disease without clinical manifestations .
- Diverticular disease with clinical manifestations . This form is characterized by a complex of symptoms, including abdominal pain and various bowel dysfunctions.
- Diverticular disease with a complicated course :
- intestinal obstruction;
- internal or external intestinal fistulas.
Symptoms, clinical picture of diverticulosis and diagnosis of the disease
Diverticulosis of the colon may not appear for a long time, and it is discovered by chance when examining patients.
The main symptoms of clinically uncomplicated colon diverticulosis are abdominal pain and bowel dysfunction. Abdominal pains are varied in nature – from mild tingling to severe colic. Most often they are localized in the lower abdomen, especially in the left iliac region or above the pubis, that is, in the area of the sigmoid colon. In some patients, these pains are varied not only in nature, but also in localization, and therefore the doctor does not always associate them with a disease of the colon.In a number of patients, pain is caused by food intake, which is explained by the influence of the gastrocolic reflex.
Intestinal dysfunction manifests itself more often in the form of constipation, and a prolonged absence of stool significantly increases the pain syndrome. Diarrhea is sometimes noted, which, however, is not permanent. Often, patients complain of unstable stools; sometimes the symptoms described are combined with nausea or vomiting.
Complications of diverticulosis are usually quite pronounced. Diverticulitis is most often observed – in about 1/3 of patients with diverticular disease of the colon.The main signs of diverticulitis are abdominal pain, fever, and leukocytosis. The appearance of the last two signs against the background of the existing clinically expressed or asymptomatic diverticulosis makes it possible to distinguish the onset of inflammation from functional pain.
With the spread of the inflammatory process in the form of paracolitis, along with the listed symptoms, the formation of an infiltrate is noted, the size of which ranges from insignificant, hardly detectable by palpation, to extensive foci occupying the entire left half of the abdomen.The progression of the inflammatory process can lead to abscess formation with the threat of a breakthrough of the abscess into the abdominal cavity. The abatement of inflammation does not always lead to a complete resorption of the infiltrate, and then induration of the mesentery or surrounding tissues simulates a tumor in the abdominal cavity.
The sigmoid colon or other parts of the colon, as a result of repeated attacks of diverticulitis, paracolitis, or the formation of an abscess, may be fused with adjacent organs. In this case, the abscess can open into the bladder, urethra, vagina, or small intestine with the formation of fistulas.
Diverticulum perforation occurs in both clinically expressed and asymptomatic colon diverticulosis. Perforation into the free abdominal cavity leads to the development of rapidly progressive peritonitis, the clinical manifestations of which do not differ from those in other forms of acute inflammation of the peritoneum. Intestinal obstruction in colon diverticulosis is obstructive in nature with all the manifestations inherent in this form. One of the common reasons for the development of obstruction in diverticulosis is the formation of the so-called pseudotumor.
Intestinal bleeding, although it does not usually have a profuse character, is still often so pronounced that it quickly attracts the attention of both the patient himself and the doctors.
Significant difficulties arise in determining the source of bleeding. Bleeding from the diverticulum is also observed in the asymptomatic course of the disease, which creates even greater diagnostic difficulties. Along with obvious bleeding, its latent forms can also be observed, manifested only by anemia.The symptoms of the listed complications, although quite striking, are not specific. In this regard, it is sometimes very difficult to determine the causes of their occurrence, and for this a comprehensive examination is used.
Clinical manifestations of colon diverticulosis and its complications cannot serve as a basis for establishing an accurate diagnosis of the disease. Diagnosis and differential diagnosis of colon diverticulosis is based on the analysis of clinical manifestations of the disease and the results of mandatory X-ray and endoscopic studies of the colon.
Conservative treatment of diverticular disease
Currently, the following principles of treatment of this disease have been formulated:
- Asymptomatic colon diverticulosis, discovered incidentally, does not require special treatment. A diet rich in plant fiber, bran is prescribed.
- for diverticulosis with severe clinical manifestations, a set of therapeutic measures is used:
- a balanced diet containing a large amount of vegetable fiber, and with persistent constipation and fluid;
- drugs that normalize bowel function;
- with a pronounced spastic component, antispasmodics or calcium channel blockers (Decitel) are prescribed, which act selectively on the intestinal wall.For pain syndrome, analgesics are prescribed, morphine preparations are contraindicated for these purposes, since they increase intraintestinal pressure;
- in the presence of diverticulitis phenomena require the appointment of antibiotics;
- antidiarrheal agents can be used for diarrhea;
- in the presence of enzymatic insufficiency of the pancreas, enzymatic preparations are prescribed;
- when dysbiosis is detected, it is advisable to use bacterial drugs (colibacterin, bifidumbacterin, bificol).
There are the following indications for surgical treatment of diverticular disease:
- perforation of the diverticulum;
- intestinal obstruction;
- profuse bleeding.
- formation of a chronic infiltrate simulating a malignant tumor;
- clinically pronounced diverticular disease, refractory to complex conservative treatment.
90,029 internal and external fistulas;
90,000 Intestinal diverticula
Intestinal diverticulosis is the presence of multiple diverticula in the small or large intestine. Diverticula are saccular protrusions of the mucous membrane through the cracks in the muscular membrane of the intestinal wall.
More often people over 40 suffer from the disease.
As a rule, diverticulosis is asymptomatic, but in some cases there is inflammation of the diverticula (diverticulitis) and painless bleeding.
Diverticulitis is accompanied by abdominal pain, fever, nausea.
Patients with asymptomatic diverticulosis do not need treatment, it is done when symptoms and complications are present, and in rare cases, surgery is required.
Diverticular disease, intestinal diverticula.
- Pain in the lower left abdomen.They can take place within a few hours, or they can last for several days.
- Soreness when palpating the abdomen.
- Alternating constipation and diarrhea.
Approximately 80% of bowel diverticulosis is asymptomatic.
General information about the disease
Intestinal diverticulosis suggests the presence of multiple diverticula in the intestine.
The intestine is an organ of the human digestive and excretory system, consisting of the small and large intestines and located in the abdominal cavity. The small intestine, starting from the stomach, flows into the large intestine, ending with the rectum and anus. The intestine is a tube formed by muscle tissue and covered with a mucous and submucous layer on the inside and a membrane consisting of connective tissue on the outside. Vessels entwine the intestines with a network along its entire length, penetrating through the muscle clefts into the submucosa. Nutrients absorbed by the mucous membrane enter the portal vein, then entering the liver to cleanse unnecessary substances.
Intestinal diverticula are saccular protrusions of the mucous membrane through the cracks in the muscular membrane of the intestinal wall. Diverticula bulge outward from the intestinal wall.
People over 40 are more susceptible to diverticulosis.
Diverticula are of two types.
- True diverticula are protrusions through defects in the muscular membrane of all layers of the intestinal wall. These include congenital diverticula – intraluminal diverticula and Meckel diverticulum. Meckel’s diverticula are the most common congenital anomalies of the gastrointestinal tract. They are formed when the vitelline duct (the duct that feeds the fetus) is incompletely infected and are located in the section of the small intestine that connects to the large intestine. Complications of Meckel’s diverticulum usually occur in children under 5 years of age.
- Pseudodiverticula (false diverticula) involve protrusion through weak areas of the muscular membrane of the intestinal mucosa and submucosa. False diverticula are most common and acquired.
The formation of false diverticula is associated with an increase in pressure in the intestinal lumen and the presence of weak points in the muscular membrane of the intestine, through which the mucous membrane protrudes.
With age, the musculoskeletal clefts, through which the vessels penetrate into the submucosa, expand, forming weak spots in the intestinal wall. The increased pressure inside the intestine may be due to the low stool volume that is common in people with low fiber intake. A small amount of hard stool travels through the intestines for a long time, increasing the pressure inside the intestine.
With a sufficient intake of fiber, the volume of feces increases, they move faster through the intestine, causing the expansion of its walls and, thus, reducing the intraluminal pressure.
Also, an increase in pressure can cause frequent straining during bowel movements.
In most cases, intestinal diverticulosis is asymptomatic and is detected by chance. Sometimes there is inflammation of the diverticula, bleeding from the diverticulum.
In cases where feces accumulate in the cavity of the diverticulum (which can occur with prolonged constipation), bacterial inflammation can develop – diverticulitis.A blockage in a diverticulum or narrow opening can disrupt the blood supply, which can also cause diverticulitis. It is accompanied by acute abdominal pain, fever, chills, deterioration in general health, and sometimes vomiting.
In the past, it was believed that nuts, seeds, popcorn clog a diverticulum with their skin and can cause diverticulitis. However, studies have shown that eating these foods is not associated with an increased risk of developing this condition.
- Inflammation of the diverticulum, spreading to the surrounding intestinal tissue, causes peridiverticulitis.In severe cases, pericolitis develops – inflammation of the entire intestinal wall and nearby organs.
- Purulent fusion of the intestinal wall with diverticulitis may result in an opening. In this case, the inflammation spreads to the peritoneum (the membrane that covers all the organs of the abdominal cavity from the outside) – peritonitis occurs – a dangerous complication that can lead to a significant deterioration in the general condition and to systemic inflammation – sepsis.
- Complications of diverticulitis also include abscesses (purulent inflammation of the diverticulum) and fistulas (passages that can connect different parts of the bowel, bowel and bladder, vagina, or abdominal wall).
- Frequent recurrent diverticulitis leads to the formation of scar tissue, due to which the intestinal wall thickens and intestinal obstruction may develop (partial or complete disruption of the passage of contents through the intestine due to mechanical obstruction).
- Bleeding usually occurs due to damage to the mucous membrane by dense feces that have entered the diverticulum. Most often they are not associated with inflammation.
- Multiple diverticula in the small intestine can lead to stagnation of intestinal contents and the growth of bacteria, which threatens with malabsorption of nutrients.
Who is at risk?
- People over 50.
- Insufficient fiber.
- Prone to regular straining during bowel movements.
- People with obesity and overweight.
Often people with diverticular disease are unaware that there are diverticula in their intestines. They are usually detected by chance during examination aimed at other purposes.
Intestinal diverticulosis can be suspected in acute inflammation of diverticula, accompanied by characteristic symptoms. In some cases, other diseases must be ruled out to make a diagnosis.
- Complete blood count. Erythrocyte and hemoglobin levels can be reduced with bleeding from diverticula. With diverticulitis, the level of leukocytes is increased.
- The erythrocyte sedimentation rate (ESR). With diverticulitis, it may be increased.
- C-reactive protein. An increase in its amount is characteristic of acute inflammation.
- Analysis of feces for occult blood. A positive result may indicate internal bleeding in the gastrointestinal tract.
Other research methods
- Irrigoscopy – X-ray examination of the large intestine with the introduction of a radiopaque contrast agent into it using an enema. Allows you to explore the relief of the mucous membrane of the colon and identify diverticula.
- Sigmoidoscopy is a visual examination of approximately 30 cm of the colon using a sigmoidoscope, a tube with a light source.
- Colonoscopy involves examining the colon by inserting a tube through the rectum.
- Ultrasound examination (ultrasound).
- Computed tomography. With its help, it is possible not only to identify a diverticulum, but also to determine the presence of an inflammatory thickening of its wall, abscesses.
Patients with asymptomatic diverticulosis do not need treatment, except in cases of giant diverticula.They are removed surgically because they have a high risk of complications.
A diet rich in fiber and dietary fiber is prescribed, drinking plenty of fluids is recommended. This contributes to an increase in stool volume, its rapid passage through the intestines and a decrease in intraluminal pressure.
For colicky pain, use moist-warm compresses on the abdomen.
Uncomplicated acute diverticulitis is usually treated on an outpatient basis. Treatment includes diet and antibiotics.With severe complications of diverticulosis, hospitalization is indicated. Surgery is usually done when the intestinal wall is damaged by inflammation or when bleeding is severe.
- Healthy food with lots of vegetables, fruits, grain products. Drinking plenty of fluids.
- Immediate bowel movement when needed. Delayed bowel movements lead to increased pressure in the intestines.
- Strong straining should be avoided during bowel movements.
- Maintaining a normal weight.
- Regular physical activity – at least 30 minutes every day (this can be not only exercise, but also brisk walking).
- Smoking cessation.
- Complete blood count
- Leukocyte formula
- Erythrocyte sedimentation rate (ESR)
- C-reactive protein, quantitative
- Fecal occult blood test
- Feldman, Friedman, Brandt.Sleisenger and Fordtran’s Gastrointestinal and Liver Disease 9 ed. Saunders. 2010. P. 2480.
- Dan L. Longo, Dennis L. Kasper, J. Larry Jameson, Anthony S. Fauci, Harrison’s principles of internal medicine (18th ed.). New York: McGraw-Hill Medical Publishing Division, 2011.
Meckel’s diverticulum ›Diseases› DoctorPiter.ru
At an early stage of embryonic development, the gut of the fetus connects to the yolk sac through the yolk duct.Normally, by the sixth week, this duct is absorbed. However, it happens that the duct remains open and connects the intestine to the abdominal wall in the navel (in this case, the contents of the intestine may be released from the navel). And in some cases, only a part of this duct remains, it is called Meckel’s diverticulum or ileal diverticulum.
Meckel’s diverticulum is often asymptomatic. It is often discovered by chance during a diagnostic examination.But in the event of any damage to the diverticulum, intestinal bleeding, intestinal obstruction, or diverticulitis may develop.
With intestinal bleeding, feces may be mixed with bright red blood if the bleeding is active. If the bleeding is minor, the stool will be black and viscous. With intussusception of the intestine, the feces in color and consistency resemble currant jelly. The patient is pale and weak due to blood loss.
With intestinal obstruction, the patient complains of constipation, vomiting, and abdominal pain.
With diverticulitis, the main symptoms of the disease are pain in the navel, fever, nausea, vomiting, and constipation.
Meckel’s diverticulum was described by the German anatomist Johann Friedrich Meckel (1781-1833). However, this pathology was known long before him. Back in 1598, Fabrikus Hildanus discovered an unusual appendage of the intestine. But it was Meckel who studied this process in detail. From 1808 to 1820, he published several works in which the scientist described this process in detail and argued that it appeared precisely in the process of abnormal development of the embryo.
Meckel’s diverticulum is found in 2% of the population. However, in many, it is found only at autopsy. Men suffer from this pathology three times more often than women. The walls of this process are the same as the walls of the intestine, but can also include ectopic tissue of the stomach, pancreas and epithelium of the large intestine. The length of the Meckel diverticulum is from 1 to 12 cm, but more often not more than 5 cm. Often the diverticulum is connected to the navel by a fibrous cord.
By itself, a diverticulum is not dangerous, but it can cause the development of diseases that require immediate surgical intervention.
Most often, complications develop in children around the age of 10 and in adults over 30 years of age. One of the most common complications is diverticulitis (inflammation of the diverticulum) occurs in about 20% of patients with Meckel’s diverticulum. Most often, these are older people. Complication develops mainly in diverticula with a narrow neck. It is in such processes that food debris accumulates, and later a bacterial infection joins.
Diverticulitis can also develop as a result of diverticulum torsion and disruption of its blood supply.Inflammation can be localized in the diverticulum itself, or it can spread to other organs of the abdominal cavity. In children, the clinical picture of Meckel’s diverticulitis is often similar to appendicitis.
Often (about 40% of cases), ulceration of Meckel’s diverticulum is also found; like inflammation, it can cause perforation of the diverticulum. Perforation occurs into the abdominal cavity, causing peritonitis.
Diverticula can cause umbilical pathologies (approximately 12%) – cysts, fistulas, fibrous cords between the diverticulum and the navel.In the case of a fistula, intestinal mucus is secreted onto the skin around the navel, causing irritation.
Intestinal obstruction (25%) can also be a complication of Meckel’s diverticulum. This can occur as a result of intestinal intussusception (insertion of one section of the intestine into another). Then the patient complains of vomiting, abdominal pain and tumor formation, which can be detected by palpation of the abdominal cavity.
Occasionally (3%), a complication of an ileal diverticulum may be neoplasm.They can be benign (lipoma, hamartoma – a nodular tumor-like formation, consisting of the same layers as the organ in which it was formed, but differing in their incorrect location) or malignant (adenocarcinoma). Tumors may present with intestinal obstruction, perforation, or bleeding.
The diagnosis is made by a gastroenterologist. One examination is not enough, it is imperative to conduct instrumental studies:
With negative results of radioisotope scanning and ongoing bleeding, diagnostic laparoscopy is performed.
Ultrasound examination (ultrasound) with Meckel’s diverticulum is informative only in children and only in 50% of cases.
Treatment of Meckel’s diverticulum is operative. An accidentally found outgrowth is removed if:
- patient over 40 years old;
- the length of the diverticulum is more than 2 cm;
- the diverticulum is inflamed;
- its wall is thinned;
- there are fibrous cords to the navel;
- the diverticulum has a narrow neck.
Also, the diverticulum is removed in those suffering from Crohn’s disease, peritonitis and ulcerative colitis, and in those cases when it caused an acute disease of the abdominal cavity.
During surgery, either only the diverticulum (diverticulectomy) or the diverticulum and part of the ileum can be removed. In this case, either laparotomy or laparoscopy is used. Nowadays, laparoscopy is more common, as it is a minimally invasive method with a low number of complications and a short rehabilitation period.
With timely surgical intervention, the prognosis is favorable, but if, despite the formidable symptoms, delay the visit to the doctor, a lethal outcome is possible.
© Dr. Peter
90,000 causes, symptoms, diagnosis, treatment at the NCC of JSC Russian Railways
Colon diverticula – are blindly ending saccular protrusions of a limited portion of the colon. Diverticulosis means the presence of multiple diverticula. The disease develops due to the weakness of the intestinal wall (the muscle tone of the colon decreases, the muscular membranes become thinner, and the supporting connective tissue is less elastic). When the intraintestinal pressure changes, such a weak wall protrudes outward from the intestinal lumen. Most often, diverticula are localized in the sigmoid and descending colon.
Colon diverticula develop mainly in people from economically developed countries.The main role in such a wide spread of this disease is played by the depletion of the diet in coarse fiber and plant fibers, which leads to the development of constipation – the most important risk factor for diverticular disease. A number of other risk factors can be named – obesity, old age, inflammatory processes in the colon.
Three forms of the disease are distinguished: asymptomatic diverticula, uncomplicated diverticular disease, when there are clinical manifestations, and diverticular disease with complications.
There are no characteristic symptoms of uncomplicated diverticulosis, patients have signs characteristic of the syndrome of colon lesions – abdominal pain without clear localization, stool disturbance, most often constipation or unstable stools (change of constipation and diarrhea), signs of intestinal dyspepsia (rumbling, bloating) …
The most common complication of diverticulosis is inflammation of the diverticula – diverticulitis. This is facilitated by violations of the evacuation of contents from diverticula, intestinal dysbiosis.Often, diverticulitis acquires a chronic recurrent course. Signs of diverticulitis are fever, increased abdominal pain, diarrhea, mucus and blood in the stool, persistent flatulence. Often, patients are hospitalized in surgical departments with a diagnosis of “acute” abdomen. Another serious complication of diverticula is intestinal bleeding. It manifests itself most often among complete well-being in the form of excretion of scarlet blood or clots in the feces; may stop as suddenly as it started. The development of intestinal stricture due to recurrent diverticulitis, compression by inflammatory infiltrate, adhesions leads to intestinal obstruction.Perforation of the diverticulum is complicated by the development of diffuse peritonitis.
Irrigoscopy and colonoscopy are the decisive methods for diagnosing colon diverticulosis.
The main challenge in detecting uncomplicated colon diverticulosis is stool regulation. This allows to some extent prevent the formation of new diverticula and prevent complications. For this purpose, a special diet, bran, oil laxatives, drugs that affect intestinal motility and the elimination of dysbiosis are prescribed.With the development of diverticulitis, the patient is hospitalized, anti-inflammatory treatment (antibiotics), antispasmodics, enzymes are prescribed. Bleeding in 80% of cases can be stopped by conservative measures (hemostatics, infusion therapy, bed rest, irrigoscopy, which in some cases has a therapeutic effect). If these measures are ineffective, an operation is performed – removal of a segment of the colon with a bleeding vessel (usually left-sided hemicolectomy).
The department of surgery of our clinic has accumulated extensive experience in performing various types of surgical interventions for colon diverticulosis, which are indicated for complications or ineffectiveness of conservative therapy for diverticular disease.
- Article updated: June 18, 2020
Colon diverticulosis is a disease in which small, up to one to two centimeters, saccular protrusions ( ).
Intestinal diverticula develop mainly in the elderly in countries with a high standard of living.
The main role in the widespread spread of this disease is played by a decrease in the amount of plant foods in the diet and the predominance of meat and flour dishes in the diet, which leads to constipation. In addition to constipation, the development of diverticula is facilitated by: obesity, flatulence (profuse gas formation), past intestinal infections (for example, dysentery), prolonged and indiscriminate use of laxatives.
What’s going on?
With age, the elasticity of the intestinal wall decreases significantly. An increase in pressure in the intestine (as a result of constipation, flatulence, etc.) leads to protrusion of some of its parts (weak points), a diverticulum is formed. Most often, diverticulosis is asymptomatic.However, sometimes patients are disturbed:
- abdominal pain, more often in the left half;
- bloating, rumbling in the stomach.
90,029 stool disorders, most often constipation or alternation of constipation and diarrhea;
Over time, due to the accumulation of feces in the diverticulum, inflammation can occur – diverticulitis . At the same time, the temperature rises, abdominal pain intensifies, mucus and blood are found in the stool, and severe flatulence worries. It is the inflammation of the diverticulum that most often causes patients with diverticulosis to go to the doctor.
In turn, diverticulitis can lead to the development of serious complications :
Intestinal bleeding – manifested by the release of scarlet blood or clots in the feces. Worried about weakness, lowering blood pressure, pallor of the skin is noted. Allocation of blood is accompanied by abdominal pain, stool disorders.
Intestinal obstruction – develops when the passage of intestinal masses is disturbed as a result of narrowing of the intestinal lumen at the place where the diverticulum originates.
Purulent inflammation of the abdominal cavity (peritonitis) develops when intestinal contents enter the abdominal cavity through a hole in the wall of the diverticulum (perforation of the diverticulum), which forms when its wall becomes thinner.
Diagnosis and Treatment
Colon diverticulosis is diagnosed by a gastroenterologist. To identify the disease, in addition to examination, you need:
- blood test;
- feces analysis;
- Irrigoscopy – X-ray examination of the intestine with its preliminary filling with a contrast agent using an enema;
- colonoscopy – using a special flexible tube (colonoscope) through the anus, a section of the intestine up to 1 meter long is examined.It is necessary to carefully prepare for the conduct of an irrigoscopy and colonoscopy.
Diverticulitis and its complications are treated in the hospital, uncomplicated diverticulosis – at home.
The main task in the treatment of uncomplicated colon diverticulosis is to normalize the stool. This prevents the formation of new protrusions and prevents inflammation of the diverticula. First of all, a diet rich in plant foods is prescribed, and the intake of wheat bran is recommended. To reduce abdominal pain, antispasmodic drugs are prescribed (no-shpa, etc.)
When diverticulitis develops, antibiotics are prescribed. Treatment of bleeding depends on its intensity. Most often, special medications are used to help stop bleeding. For other complications of diverticulosis (perforation of the diverticulum or narrowing of the intestinal lumen), as well as ineffectiveness of therapeutic treatment, surgical intervention is used. Most often, during the operation, the affected area of the intestine is removed.
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Non-surgical treatments for colon diverticulitis (literature review) | Timerbulatov
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90,000 Meckel’s diverticulum in children – causes, symptoms, diagnosis and treatment
Meckel’s diverticulum in children – congenital anomaly of the ileum resulting from a violation of the obliteration of the proximal part of the vitelline duct.Meckel’s diverticulum in children is dangerous for its complications: bleeding, intestinal obstruction, inflammation, perforation, infringement, tumor processes. In order to diagnose Meckel’s diverticulum in children, X-ray of the small intestine with barium suspension, scintigraphy, ultrasound and CT of the abdominal organs, laparoscopy are performed. Complicated cases of Meckel’s diverticulum in children require surgical tactics – resection of the diverticulum or a section of the intestine.
Meckel’s diverticulum in children is a malformation of the small intestine, which is a pathological saccular protrusion in the lower third of the ileum.Meckel’s diverticulum is one of the most common congenital abnormalities of the gastrointestinal tract, detected in 2-3% of children, more often in boys. In half of the cases, the manifestation of clinical manifestations develops in children under 10 years old, in the rest – at the age of up to 30 years. Meckel’s diverticulum in children is a rather insidious pathology: it is difficult to diagnose, it can have an asymptomatic course throughout life or declare itself as a clinic of an acute abdomen already in early childhood. Improvement of diagnostic and therapeutic algorithms for Meckel diverticulum in children is an urgent task of pediatric abdominal surgery and pediatrics in general.
Meckel diverticulum in children
Causes of Meckel diverticulum in children
Meckel diverticulum in children is an embryonic defect, that is, it is formed during intrauterine development.
In the first months of fetal development, the embryonic yolk duct functions, which is part of the umbilical cord and connects the terminal part of the ileum with the yolk sac. At 3-5 months of embryonic development, obliteration of the vitelline duct and its atrophy normally occur.In the case of incomplete obliteration and preservation of the bile duct by the time of the birth of the child, in one form or another, the following types of anomalies are distinguished: incomplete and complete fistulas of the navel, enterocystoma, Meckel’s diverticulum.
In most cases, a Meckel diverticulum in children is formed in the lower third of the ileum at a distance of 60-80 cm from the ileocecal (ileo-cecal) angle. Usually the diverticulum has a length of about 3-4 cm, the shape of a cone or cylinder, is located on the wall of the ileum opposite the mesentery.Meckel’s diverticulum in children belongs to true diverticula, since its wall completely repeats the morphological structure of the ileal wall. However, ectopic gastric mucosa, capable of producing hydrochloric acid, or pancreatic tissue, is often found in the wall of the diverticulum. The presence of ectopic glandular epithelium of the stomach in Meckel’s diverticulum in children causes ulceration of its wall and gastrointestinal bleeding.
Meckel’s diverticulum in children is often combined with atresia of the esophagus, atresia of the anus and rectum, omphalocele, Crohn’s disease.
Symptoms of a Meckel diverticulum in children
Uncomplicated Meckel diverticulum in children is asymptomatic and may be an accidental finding during laparotomy for another disease, or it may not be recognized. The clinical manifestation of Meckel’s diverticulum in children is usually associated with the development of complications: intestinal bleeding, inflammation (diverticulitis), intestinal obstruction (intussusception, strangulation), tumors.
Bleeding from a peptic ulcer, as the most common complication of Meckel’s diverticulum in children, can be acute, profuse or chronic, latent.A sign of intestinal bleeding with Meckel’s diverticulum in children is tarry, black stools. Bleeding is accompanied by general weakness, dizziness, tachycardia, pallor, clinical and laboratory signs of post-hemorrhagic anemia. Unlike bleeding from varicose veins of the esophagus or stomach and duodenal ulcers, children with complicated Meckel diverticulum never vomit “coffee grounds”.
The clinic of acute diverticulitis complicating Meckel’s diverticulum in children resembles the symptoms of acute appendicitis.The child has abdominal pain (near the navel or in the right iliac region), nausea, fever, leukocytosis, a positive Shchetkin-Blumberg symptom. Usually, the correct diagnosis is made intraoperatively, when an intact vermiform appendix is detected, and a revision of the ileum reveals the presence of an inflamed Meckel diverticulum in a child. Inflammation and ulceration of Meckel’s diverticulum in children can cause its perforation into the free abdominal cavity with the development of peritonitis.
Intestinal obstruction caused by Meckel’s diverticulum in children is accompanied by nausea, vomiting, cramping abdominal pain, and increasing intoxication. Obstruction can be caused by intussusception, twisting of the ileal loops around the diverticulum, entrapment of the intestinal loops.
Sometimes in children there is an infringement of the Meckel diverticulum in the hernial sac of an inguinal or femoral hernia (Litre hernia). Between infringement of a hernia, there is a sharp pain, tension and irregularity of the hernial protrusion, the absence of a symptom of a cough impulse.
Less common than other complications, children have tumors of Meckel’s diverticulum, both benign (hamartomas, fibroids, lipomas) and malignant (adenocarcinomas, carcinoid). Clinical manifestations of Meckel diverticulum tumors in children may be associated with intestinal obstruction, wall perforation, and bleeding.
Diagnosis of Meckel diverticulum in children
Preoperative diagnosis of Meckel diverticulum in children is established in less than 10% of cases. Physical examination usually shows signs of muscle tension, local tenderness, and irritation of the peritoneum.Of the laboratory tests, the most important are clinical and biochemical blood tests, feces for occult blood.
Ultrasound of the abdominal organs usually reveals signs of an inflammatory process, but does not allow a clear topical diagnosis. The identification of Meckel diverticulum in children is facilitated by X-ray of the small intestine with contrasting with a suspension of barium sulfate. In children with Meckel’s diverticulum complicated by bleeding, scintigraphy with the radioactive isotope technetium-99t (Meckel scan) is the gold standard of diagnosis, which allows detecting ectopic gastric mucosa with a sensitivity of 75-100%.To exclude other causes of bleeding, esophagogastroduodenoscopy, colonoscopy for the child is performed.
If intestinal obstruction is suspected, a plain X-ray of the abdominal cavity, CT scan of the abdominal cavity is performed. Sometimes Meckel’s diverticulum in children is detected only during the process of diagnostic laparoscopy or laparotomy.
With Meckel’s diverticulum, it is required to exclude a bleeding duodenal ulcer, acute appendicitis in children, colon polyposis.
Treatment of Meckel diverticula in children
There is no consensus regarding asymptomatic Meckel diverticula in children.Some pediatric surgeons believe that an unchanged diverticulum that is accidentally discovered during an operation should not be removed; others insist on its mandatory removal if the surgical situation is favorable.
Meckel’s diverticulum in children, complicated by inflammation, perforation, bleeding, intestinal obstruction, entrapment, clearly requires urgent surgical intervention. In this case, the child can undergo excision of the diverticulum of the small intestine (diverticulectomy) or segmental resection of the small intestine with the imposition of an end-to-end enteroenteroanastomosis.In pediatric surgery, endoscopic resection of the small intestine is preferred.
The method of choice for the treatment of diverticulitis in children is conservative drug therapy: infusion of antibiotics, injections of anti-inflammatory drugs. With the recurrent nature of inflammation of the Meckel diverticulum in children, the issue of diverticulum resection is resolved.
With the development of peritonitis, in addition to resection of the small intestine, it is necessary to drain and sanitize the abdominal cavity, prescribe massive antibiotic therapy, infusion and detoxification therapy.
Prognosis of Meckel diverticulum in children
In 95% of cases, Meckel diverticulum remains asymptomatic throughout life; complications of Meckel’s diverticulum develop only in 4-5% of children.
In case of complicated course of Meckel diverticulum in children, the timeliness of hospitalization and surgical treatment affects the outcome of the disease.