What is the difference between ulcerative colitis and diverticulitis? Learn about their symptoms, causes, diagnosis, and treatment. Get the facts you need to understand these two gastrointestinal conditions.

Understanding the Differences Between Ulcerative Colitis and Diverticulitis

Ulcerative Colitis (UC) and Diverticulitis are two distinct gastrointestinal conditions that can share some similar symptoms, but have significant differences in their underlying causes, diagnostic approaches, and treatment strategies.

Symptoms: Similarities and Differences

Both UC and diverticulitis can cause symptoms like abdominal pain, cramping, diarrhea, and bleeding. However, UC is more likely to be associated with urgency to have a bowel movement, difficulty passing stool despite the urge, weight loss, and fatigue. Diverticulitis, on the other hand, is more commonly linked to nausea, vomiting, bloating, and constipation.

Causes and Risk Factors

The causes of UC and diverticulitis differ. UC is thought to be an autoimmune condition where the body’s immune system mistakenly attacks the lining of the colon. Diverticulitis, in contrast, is caused by the development of small pouches (diverticula) in the colon wall that become inflamed or infected. Risk factors for both conditions include age, race, and diet, but the specific mechanisms differ.

Diagnosis: Approaches and Differences

Diagnosing UC and diverticulitis may involve similar tests, such as endoscopies, imaging, and blood work. However, the specific diagnostic criteria and the focus of the tests differ. For UC, the goal is to identify inflammation and ulceration in the colon, while for diverticulitis, the focus is on detecting the presence and state of the diverticula.

Treatment: Strategies and Differences

The treatment approaches for UC and diverticulitis also vary. UC is typically managed with medications that target the underlying inflammation, such as corticosteroids or biologics. In severe cases, surgery may be required. Diverticulitis, on the other hand, is often treated with antibiotics, dietary modifications, and, in some cases, hospitalization for severe episodes.

Outlook and Prognosis

UC is a chronic, lifelong condition that can lead to serious complications if left untreated. Diverticulitis, while potentially recurrent, is often a one-time or intermittent condition that can be managed effectively with appropriate treatment.

Key Takeaways

In summary, while UC and diverticulitis share some common symptoms, they are distinct conditions with different underlying causes, diagnostic approaches, and treatment strategies. Understanding these differences is crucial for ensuring proper management and improving patient outcomes.

Do you have any other questions about the differences between ulcerative colitis and diverticulitis? Let me know, and I’ll be happy to provide more information.

How can one differentiate between the symptoms of ulcerative colitis and diverticulitis? The main differences are that ulcerative colitis is more likely to cause urgency to have a bowel movement, difficulty passing stool despite the urge, weight loss, and fatigue, while diverticulitis is more commonly linked to nausea, vomiting, bloating, and constipation.

What are the key risk factors for developing ulcerative colitis and diverticulitis? Both conditions are more common with increasing age, and there are also racial differences, with white individuals being more susceptible. For ulcerative colitis, there may also be a genetic component, while diverticulitis is associated with factors like obesity, lack of exercise, and a diet low in fiber.

How do doctors diagnose ulcerative colitis and diverticulitis? The diagnostic approaches for these two conditions involve similar tests, such as endoscopies, imaging, and blood work, but the specific focus of the tests differs. For ulcerative colitis, the goal is to identify inflammation and ulceration in the colon, while for diverticulitis, the focus is on detecting the presence and state of the diverticula.

What are the primary treatment strategies for ulcerative colitis and diverticulitis? Ulcerative colitis is typically managed with medications that target the underlying inflammation, such as corticosteroids or biologics, while severe cases may require surgery. Diverticulitis, on the other hand, is often treated with antibiotics, dietary modifications, and, in some cases, hospitalization for severe episodes.

Ulcerative Colitis vs. Diverticulitis: What’s the Difference?

Written by Shishira Sreenivas

• Ulcerative Colitis and Diverticulitis: Similarities and Differences
• How Are Symptoms the Same and Different?
• How Are Causes and Risk Factors the Same and Different?
• How Is Diagnosis the Same and Different?
• How Is Treatment the Same and Different?
• Ulcerative Colitis and Diverticulitis: What’s the Outlook?
• More

If you’ve had stomach pain for a while and see blood when you poop, you might have ulcerative colitis (UC) or diverticulitis. The two conditions are different, but some of their symptoms can be the same because they’re both conditions in the large intestine or colon.

UC is a type of inflammatory bowel disease (IBD) that irritates the lining in your large intestine (also known as the colon). This causes tiny open sores, called ulcers, that produce pus and mucous.

Diverticulitis is a condition that you have when one or more tiny, bulging pouches (called diverticula) form over weak spots in the colon wall, and then tear and become infected or inflamed. Diverticula are usually pea-sized and can form anywhere throughout the colon. But they’re commonly found in the lower-left side of your large intestine called the sigmoid colon.

UC and diverticulitis both start out in the large intestine and share symptoms like belly pain and bloody poop. Both conditions are more likely the older you get, and both can range from mild to severe and vary for each person. But they differ in terms of what causes them and how your doctor might treat them.

UC is a lifelong condition that can lead to life-threatening problems. About a million Americans are affected by it. It can affect people at any age, including those in their 20s and 30s. If you have UC, you also might have weight loss or arthritis.

Diverticulitis, not a lifelong condition, is a complication of “diverticulosis.” It’s the term doctors use when one or more of the small bulging sacs grow on your colon wall. It usually starts in middle age and it’s common in older people. Diverticulitis can happen to you once and never happen again, or it might come and go. About 50% of those over the age of 60 have it, and almost everyone above 80 has it, too. Most are mild cases that don’t cause any symptoms and aren’t reasons to worry. Up to 30% of the people with diverticulosis go on to have diverticulitis. And among them, anywhere between 5%-15% will have symptoms like bloody poop.

UC and diverticulitis have some of the same symptoms, but they also have some that are different.

Shared ones include:

• Belly pain
• Cramping
• Diarrhea
• Bleeding
• Fever

If you have one or more of these symptoms, talk to your doctor. UC symptoms also include:

• Urgency to poop
• Trouble pooping despite the urgency
• Weight loss
• Fatigue
• Lack of growth in children

Diverticulitis symptoms also include:

• Nausea
• Vomiting
• Swelling or bloating
• Constipation

It’s important to note that if you have diverticulitis, you’re more likely to have constipation than diarrhea.

Doctors aren’t sure what causes you to get UC or diverticulitis, but the two conditions have some common risk factors:

• Age. Your odds for either condition go up as you get older.
• Race. White people are more likely than those of any other race to have UC or diverticulitis.

UC might be caused by an abnormal immune response in your body. This means that if your immune system is fighting off a virus or bacteria, it may mistakenly attack cells in your digestive tract, too.

Genes might also play a role. If a close relative like your parent or sibling has UC, you’re more likely to have it, too. If you’re of Ashkenazi Jewish descent (ancestors came from Eastern or Central Europe), your risk is even higher. Diet and stress don’t cause UC, but they may trigger your symptoms and cause flare-ups.

As for what causes diverticulitis, experts believe bacteria found in your poop might get pushed into the bulging sacs as it passes through the colon. This causes the sacs to become infected or inflamed. Another theory is that your poop, especially if you’re constipated, might put a lot of pressure against the colon walls as it passes through. This can cause tears in the sacs and increase your chances of an infection.

Other risk factors for diverticulitis include:

• Obesity
• Smoking
• Lack of exercise
• Diet low in fiber and high in animal fat
• Certain medications (like steroids, opioids, and nonsteroidal anti-inflammatory drugs like ibuprofen)

If you think you have either UC or diverticulitis, talk to your doctor about it. You might be referred to a gastroenterologist, a doctor who specializes in digestive issues, for a correct diagnosis.

Your doctor will first do a detailed medical exam. They’ll ask you about your medical history including things like your diet, your bowel movements, and medications you might be taking.

Common tests to diagnose UC and diverticulitis include:

• Blood tests. This is done to check for infections
• Stool sample test. This checks for bacteria or parasites that might cause your stomach pain, cramps, or diarrhea
• Colonoscopy. The doctor will use a thin, flexible tube with a camera on the tip to explore your entire colon. They may take small tissue samples to test.
• Flexible sigmoidoscopy. This is similar to a colonoscopy, except your doctor will only explore your rectum and s-shaped sigmoid colon – both of which are located at the lower end of your colon. This is usually done if you have severe inflammation.
• Barium enema. This test is also called lower gastrointestinal tract radiography. In this test, your doctor injects a liquid containing barium into your butt. The barium coats your entire colon and makes it easier to see clearly under an X-ray scan.
• CT scan. This test allows your doctor to scan your abdomen and pelvic area and spot inflamed areas in your colon. The scan can detect the irritated or inflamed pouches for diverticulitis and confirm the condition.

In both conditions, treatments usually involve medications or, sometimes, surgery. In severe cases, your doctor may recommend a combination of the two to bring your symptoms under control. Certain over-the-counter medications may ease some of your pain-related symptoms. These include:

• Anti-diarrheal medications
• Pain relievers
• Antispasmodics to ease cramps and bloating
• Iron supplements, especially if you’re bleeding

UC treatments may include:

Anti-inflammatory drugs. This is usually the first line of treatment. This can include drugs like 5-aminosalicylates and corticosteroids. Some newer drugs like sulfasalazine and 5-ASAs (like mesalamine), which are called “steroid-sparing,” can be safely taken long-term. Your doctor may not want you to take steroids long-term because of their side effects.

Immunosuppressant drugs. This helps to reduce inflammation in your colon and cut down the immune response that might attack your digestive cells.

Biologics. This targets the proteins made by your immune system.

Surgery. About 30% of people who have UC need surgery. It’s sometimes the only cure, especially if medications don’t ease your symptoms or they become too difficult to manage. Your doctor may consider a surgery called proctocolectomy.

In this procedure, your entire colon and rectum are removed. Most surgeries also involve a procedure in which your doctor will attach a pouch at the end of the small intestine or outside your body to pass poop directly into it.

Diverticulitis treatments may include:

Antibiotics. If your case is mild, your doctor may prescribe oral antibiotics to bring the symptoms under control. If you have multiple bouts of diverticulitis episodes, you’ll need to go to the hospital for intravenous (IV) antibiotics and fluids. At this point, your doctor may consider surgery as an option, too.

Surgery. Your doctor may recommend you have surgery for diverticulitis because of issues in your colon such as:

• Abscess (a type of walled-off infection)
• Obstruction
• Tears that cause pus or poop to leak into your stomach cavity
• Tunnel-like opening in the colon that connects with other organs (fistula)
• Continuous bleeding (if your diverticulitis is recurring)

In some cases, you may need a colostomy bag after surgery. It’s a pouch that’s attached outside of your body to pass poop into if your colon needs time to heal. Once your colon is healthy, your doctor might remove the colostomy bag.

UC is a lifelong condition, and your symptoms may come and go. About 30% of people with UC have severe symptoms, and flare-ups might happen more frequently. While medications often help, surgery may also be needed.

In contrast, most cases of diverticulitis, even though it’s also considered a lifelong condition, clear up with a 7- to 10-day course of antibiotics and plenty of rest. If you have severe symptoms, talk to your doctor about other treatment options.

Managing your diet and stress and making time for regular physical exercise are key to lowering your risks for both conditions. However, because some of the symptoms are specific, there are steps you can take to avoid your condition flaring up or getting worse.

To prevent diverticulitis, you should:

• Eat more fiber. This helps your poop move better in your digestive tract and reduces any pressure on the colon walls
• Drink lots of water, this prevents constipation.

If you’re not sure what to eat, talk to your doctor.

To lower your odds for UC or manage flare-ups, you should:

• Get plenty of sleep. This can ease emotional stress and keep your immune system in check.
• Avoid using too many nonsteroidal anti-inflammatory drugs (NSAIDs). For pain relief and fever, switch to alternatives like acetaminophen (Tylenol).
• Be careful when you take antibiotics. These drugs can trigger UC flare-ups. Let your doctor know if it does.

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Ulcerative Colitis vs. Diverticulitis: What’s the Difference?

Written by Shishira Sreenivas

• Ulcerative Colitis and Diverticulitis: Similarities and Differences
• How Are Symptoms the Same and Different?
• How Are Causes and Risk Factors the Same and Different?
• How Is Diagnosis the Same and Different?
• How Is Treatment the Same and Different?
• Ulcerative Colitis and Diverticulitis: What’s the Outlook?
• More

If you’ve had stomach pain for a while and see blood when you poop, you might have ulcerative colitis (UC) or diverticulitis. The two conditions are different, but some of their symptoms can be the same because they’re both conditions in the large intestine or colon.

UC is a type of inflammatory bowel disease (IBD) that irritates the lining in your large intestine (also known as the colon). This causes tiny open sores, called ulcers, that produce pus and mucous.

Diverticulitis is a condition that you have when one or more tiny, bulging pouches (called diverticula) form over weak spots in the colon wall, and then tear and become infected or inflamed. Diverticula are usually pea-sized and can form anywhere throughout the colon. But they’re commonly found in the lower-left side of your large intestine called the sigmoid colon.

UC and diverticulitis both start out in the large intestine and share symptoms like belly pain and bloody poop. Both conditions are more likely the older you get, and both can range from mild to severe and vary for each person. But they differ in terms of what causes them and how your doctor might treat them.

UC is a lifelong condition that can lead to life-threatening problems. About a million Americans are affected by it. It can affect people at any age, including those in their 20s and 30s. If you have UC, you also might have weight loss or arthritis.

Diverticulitis, not a lifelong condition, is a complication of “diverticulosis.” It’s the term doctors use when one or more of the small bulging sacs grow on your colon wall. It usually starts in middle age and it’s common in older people. Diverticulitis can happen to you once and never happen again, or it might come and go. About 50% of those over the age of 60 have it, and almost everyone above 80 has it, too. Most are mild cases that don’t cause any symptoms and aren’t reasons to worry. Up to 30% of the people with diverticulosis go on to have diverticulitis. And among them, anywhere between 5%-15% will have symptoms like bloody poop.

UC and diverticulitis have some of the same symptoms, but they also have some that are different.

Shared ones include:

• Belly pain
• Cramping
• Diarrhea
• Bleeding
• Fever

If you have one or more of these symptoms, talk to your doctor. UC symptoms also include:

• Urgency to poop
• Trouble pooping despite the urgency
• Weight loss
• Fatigue
• Lack of growth in children

Diverticulitis symptoms also include:

• Nausea
• Vomiting
• Swelling or bloating
• Constipation

It’s important to note that if you have diverticulitis, you’re more likely to have constipation than diarrhea.

Doctors aren’t sure what causes you to get UC or diverticulitis, but the two conditions have some common risk factors:

• Age. Your odds for either condition go up as you get older.
• Race. White people are more likely than those of any other race to have UC or diverticulitis.

UC might be caused by an abnormal immune response in your body. This means that if your immune system is fighting off a virus or bacteria, it may mistakenly attack cells in your digestive tract, too.

Genes might also play a role. If a close relative like your parent or sibling has UC, you’re more likely to have it, too. If you’re of Ashkenazi Jewish descent (ancestors came from Eastern or Central Europe), your risk is even higher. Diet and stress don’t cause UC, but they may trigger your symptoms and cause flare-ups.

As for what causes diverticulitis, experts believe bacteria found in your poop might get pushed into the bulging sacs as it passes through the colon. This causes the sacs to become infected or inflamed. Another theory is that your poop, especially if you’re constipated, might put a lot of pressure against the colon walls as it passes through. This can cause tears in the sacs and increase your chances of an infection.

Other risk factors for diverticulitis include:

• Obesity
• Smoking
• Lack of exercise
• Diet low in fiber and high in animal fat
• Certain medications (like steroids, opioids, and nonsteroidal anti-inflammatory drugs like ibuprofen)

If you think you have either UC or diverticulitis, talk to your doctor about it. You might be referred to a gastroenterologist, a doctor who specializes in digestive issues, for a correct diagnosis.

Your doctor will first do a detailed medical exam. They’ll ask you about your medical history including things like your diet, your bowel movements, and medications you might be taking.

Common tests to diagnose UC and diverticulitis include:

• Blood tests. This is done to check for infections
• Stool sample test. This checks for bacteria or parasites that might cause your stomach pain, cramps, or diarrhea
• Colonoscopy. The doctor will use a thin, flexible tube with a camera on the tip to explore your entire colon. They may take small tissue samples to test.
• Flexible sigmoidoscopy. This is similar to a colonoscopy, except your doctor will only explore your rectum and s-shaped sigmoid colon – both of which are located at the lower end of your colon. This is usually done if you have severe inflammation.
• Barium enema. This test is also called lower gastrointestinal tract radiography. In this test, your doctor injects a liquid containing barium into your butt. The barium coats your entire colon and makes it easier to see clearly under an X-ray scan.
• CT scan. This test allows your doctor to scan your abdomen and pelvic area and spot inflamed areas in your colon. The scan can detect the irritated or inflamed pouches for diverticulitis and confirm the condition.

In both conditions, treatments usually involve medications or, sometimes, surgery. In severe cases, your doctor may recommend a combination of the two to bring your symptoms under control. Certain over-the-counter medications may ease some of your pain-related symptoms. These include:

• Anti-diarrheal medications
• Pain relievers
• Antispasmodics to ease cramps and bloating
• Iron supplements, especially if you’re bleeding

UC treatments may include:

Anti-inflammatory drugs. This is usually the first line of treatment. This can include drugs like 5-aminosalicylates and corticosteroids. Some newer drugs like sulfasalazine and 5-ASAs (like mesalamine), which are called “steroid-sparing,” can be safely taken long-term. Your doctor may not want you to take steroids long-term because of their side effects.

Immunosuppressant drugs. This helps to reduce inflammation in your colon and cut down the immune response that might attack your digestive cells.

Biologics. This targets the proteins made by your immune system.

Surgery. About 30% of people who have UC need surgery. It’s sometimes the only cure, especially if medications don’t ease your symptoms or they become too difficult to manage. Your doctor may consider a surgery called proctocolectomy.

In this procedure, your entire colon and rectum are removed. Most surgeries also involve a procedure in which your doctor will attach a pouch at the end of the small intestine or outside your body to pass poop directly into it.

Diverticulitis treatments may include:

Antibiotics. If your case is mild, your doctor may prescribe oral antibiotics to bring the symptoms under control. If you have multiple bouts of diverticulitis episodes, you’ll need to go to the hospital for intravenous (IV) antibiotics and fluids. At this point, your doctor may consider surgery as an option, too.

Surgery. Your doctor may recommend you have surgery for diverticulitis because of issues in your colon such as:

• Abscess (a type of walled-off infection)
• Obstruction
• Tears that cause pus or poop to leak into your stomach cavity
• Tunnel-like opening in the colon that connects with other organs (fistula)
• Continuous bleeding (if your diverticulitis is recurring)

In some cases, you may need a colostomy bag after surgery. It’s a pouch that’s attached outside of your body to pass poop into if your colon needs time to heal. Once your colon is healthy, your doctor might remove the colostomy bag.

UC is a lifelong condition, and your symptoms may come and go. About 30% of people with UC have severe symptoms, and flare-ups might happen more frequently. While medications often help, surgery may also be needed.

In contrast, most cases of diverticulitis, even though it’s also considered a lifelong condition, clear up with a 7- to 10-day course of antibiotics and plenty of rest. If you have severe symptoms, talk to your doctor about other treatment options.

Managing your diet and stress and making time for regular physical exercise are key to lowering your risks for both conditions. However, because some of the symptoms are specific, there are steps you can take to avoid your condition flaring up or getting worse.

To prevent diverticulitis, you should:

• Eat more fiber. This helps your poop move better in your digestive tract and reduces any pressure on the colon walls
• Drink lots of water, this prevents constipation.

If you’re not sure what to eat, talk to your doctor.

To lower your odds for UC or manage flare-ups, you should:

• Get plenty of sleep. This can ease emotional stress and keep your immune system in check.
• Avoid using too many nonsteroidal anti-inflammatory drugs (NSAIDs). For pain relief and fever, switch to alternatives like acetaminophen (Tylenol).
• Be careful when you take antibiotics. These drugs can trigger UC flare-ups. Let your doctor know if it does.

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Diverticulum of the stomach.

What is a gastric diverticulum?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

A diverticulum of the stomach is a congenital or acquired protrusion of the stomach wall, which is usually localized on the posterior surface of its cardiac section. Most often it is asymptomatic, the clinic usually develops when complications appear (inflammation, ulceration, bleeding, etc.). In the diagnosis, radiography with contrast and esophagogastroduodenoscopy are informative. In the absence of complications, the treatment is conservative, with a large size of the diverticulum and its complicated course, surgery is required.

ICD-10

K31.4 Gastric diverticulum

• Causes
• Pathoanatomy
• Symptoms of gastric diverticulum
• Complications
• Diagnostics
• Treatment of gastric diverticulum
• Prognosis and prevention
• Prices for treatment

General

Diverticulum of the stomach is a rather rare disease that equally affects men and women, more often after 40 years. The incidence is 0.01-0.05% of the entire pathology of this organ. However, the improvement of diagnostic procedures in the field of modern gastroenterology suggests that in fact the prevalence of this nosology is somewhat higher – gastric diverticulum is found in 3% of all gastroscopy cases.

Since the course of this pathology in most cases is asymptomatic, diagnosis can be difficult. There are known cases of detection of gastric diverticulum at autopsy in people during whose lifetime this diagnosis was not established. Diverticula can have a variety of shapes and sizes; the prognosis of the course of the disease worsens in proportion to the size of the protrusion.

Diverticulum of the stomach

Causes

Diverticulum of the stomach can be congenital or acquired. Congenital diverticula are the result of an anomaly in the development of the organ wall. Their difference from the acquired ones is the structure of the wall: all layers (mucous, muscular, serous) are present in it. Congenital protrusions often have their own peristalsis, less often complicated.

Acquired diverticula of the stomach are associated with other pathology of the abdominal organs, surgery. The predisposition to pathology is due to the special structure of the muscular membrane of the stomach in the cardiac region, where diverticula are most often found. Longitudinal fibers gradually diverge from the cardia to the greater and lesser curvature, which creates prerequisites for the prolapse of the mucosa between them under certain conditions.

Two groups of factors lead to the formation of a gastric diverticulum. The first includes any diseases that cause spastic contraction of the walls of the stomach and an increase in pressure in the cavity of the organ: inflammatory diseases of the gastrointestinal tract (gastritis, gastroduodenitis, gastric ulcer), tumors. It is known that ordinary peristaltic contractions of the stomach cannot provoke an increase in intracavitary pressure sufficient to form a protrusion.

The second group of factors includes operations and adhesions of the abdominal cavity, as a result of which there are constant tractions of the stomach wall from the outside, stimulating the formation of a saccular formation. With a mixed genesis, a gastric diverticulum can form as a result of an increase in pressure in the organ cavity, and then the size of the protrusion progresses due to tractions of the stomach wall.

Pathology

In 75% of cases, diverticula are located in the cardia, along the back wall of the stomach, about two centimeters from the esophageal opening of the diaphragm (this localization is most characteristic of congenital diverticula). Much less often, protrusions of the stomach wall are located along the greater curvature (10%), in the pyloric region (8%). Diverticula of other localization occur in no more than 2% of cases. In addition, formations are almost never located along the anterior wall of the stomach.

The difference between congenital and acquired diverticula is their shape and size. Since the congenital diverticulum has a muscular membrane, its shape is usually correct, rounded, and its own peristalsis is observed in it. The sizes of congenital protrusions are often small, no more than 3-4 cm. Acquired diverticula are characterized by a round, oval or pear-shaped shape, they do not peristaltize. In small formations under the mucosa, a thin muscle layer can be determined; in medium-sized diverticula single muscle fibers are detected; in large diverticula of the stomach, this layer is absent.

Symptoms of gastric diverticulum

The disease is characterized by an asymptomatic course, due to which many patients do not even suspect that they have this disease. In rare cases, different variants of the clinical course are possible. The dyspeptic form is accompanied by nausea, vomiting, heartburn, belching, and periodic diarrhea. Also, the diverticulum can be manifested by the clinical picture of a stomach ulcer: acute abdominal pain, vomiting of coffee grounds, chalk, lack of appetite.

Rarely enough, the pathology is disguised as an oncological disease, vague pains, asthenia and exhaustion phenomena, and anemia are noted. The course of the disease can be characterized by periods of exacerbation, during which the patient makes the above complaints, and remission, when nothing bothers him.

Complications

Diverticulum of the stomach can be complicated by an inflammatory process – this condition is called diverticulitis. The longer the inflammation persists in the diverticulum, the more likely it is to progress with the formation of ulcers, bleeding, and perforation. In this case, the patient has a clinic of an acute abdomen. Extremely rarely observed malignancy of the protrusion.

Diagnostics

During a routine consultation with a gastroenterologist, it is almost impossible to suspect a gastric diverticulum in a patient, since this disease does not have a characteristic clinical picture. However, the specialist may prescribe additional studies that will establish the correct diagnosis. To identify the diverticulum of the stomach, two methods are of greatest importance: radiography of the stomach with contrast and esophagogastroduodenoscopy.

Radiography of the stomach is carried out in various positions: horizontal, with the head and foot ends lowered. This allows the contrast to fill the diverticulum well. At the same time, a plus-shadow is determined on the radiograph, similar to the picture of an ulcerative niche. The difference between small diverticula and gastric ulcers is the presence of a neck, a horizontal level in the protrusion.

EGDS makes it possible to identify the entrance to the diverticulum, examine its walls, assess the size and condition of its cavity. If the diverticulum is congenital, then the folds of the mucous membrane continue from the walls of the stomach through the neck to the diverticulum. Peristalsis of the stomach is not disturbed. Mucous diverticulum has a well-defined relief. The difference of the acquired diverticulum is the breakage of the mucosal folds at the entrance to its cavity, the decrease in peristalsis in this area.

Treatment of gastric diverticulum

An uncomplicated diverticulum does not require treatment. After the initial detection of this disease, control (radiological or endoscopic) is necessary after six months. If inflammation and other complications of the pathology are not detected, then follow-up control is performed annually. In the presence of an unexpressed inflammatory process, the patient is hospitalized in the department of gastroenterology for conservative treatment.

Surgical treatment is carried out when a large diverticulum is detected, ulceration and chronic bleeding, intractable diverticulitis. Increasingly, surgeons are resorting to laparoscopic excision of the gastric diverticulum (diverticulectomy) – this method is safer, provides a quick recovery after surgical treatment. During the operation, excision of the diverticulum is performed, two-layer suturing of the tissues of the stomach.

Sometimes during laparotomic diverticulectomy it can be difficult to find the protrusion itself, in this situation the help of an endoscopist is required. The endoscope is inserted into the formation cavity, which makes it easy to find it. Also, through the endoscope, a barium suspension or methylene blue solution can be introduced into the protrusion area, which will also facilitate the detection of the diverticulum.

Prognosis and prevention

Detection of a diverticulum of the stomach requires the patient to be registered with a dispensary. There is no specific prevention of the disease, however, the timely treatment of inflammatory diseases of the stomach, the introduction of sparing methods of surgical interventions to prevent the formation of adhesions will help to reduce the likelihood of the formation of an acquired protrusion of the wall. The outcome in the uncomplicated course of the disease is favorable, the presence of a diverticulum does not affect the life and performance of the patient. The development of complications worsens the prognosis of the disease.

You can share your medical history, what helped you in the treatment of gastric diverticulum.

Sources

1. self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

   Meckel’s diverticulum in adults and children

   Meckel’s diverticulum (named after the German anatomist J. Meckel, 1809) is a local sac-like protrusion of the ileum wall, formed as a result of incomplete occlusion of the vitelline duct, which participates in the nutrition of the embryo at a distance of 10-100 cm from ileocecal angle [1-3], is the most common congenital anomaly of the gastrointestinal tract. The average length of the diverticulum is 5-7 cm.

   Meckel’s diverticulum (DM) in most cases is located on the distal segment of the ileum – 50 cm from the ileocecal junction. The main clinical manifestations of DM are melena, pain in the right lower quadrant of the abdomen, intestinal volvulus, intestinal obstruction, and inflammatory complications (diverticulitis). American surgeons have a “rule of two” regarding DM: 2 inches long, 2 feet from the ileocecal angle, 2% in the population, the clinic most often manifests during the first 2 years of life, 2 types of ectopic tissue (stomach and pancreas) and 2 times more common in males [18]. However, precise values ​​for these criteria are in the range of 0.2–5.0 (eg, prevalence probability in the range of 0.2–4.0%).

   The epithelium of about 1/3 of the DM is of the glandular type, capable of producing hydrochloric acid, so chronic ulcers may occur, followed by perforation or bleeding [4].

   In some cases, violations of the reverse development of the vitelline duct, DM can turn into a strong cicatricial cord attached from the inside to the umbilical ring, which can lead to acute intestinal obstruction [5].

   DM is the most common congenital malformation of the gastrointestinal tract [6]. Bleeding due to mucosal ectopia is the most common complication in children, but rare in adults. Due to the rare occurrence of DM, it is difficult to diagnose before surgery, with the introduction of Tc-9 scanning9 pertechnetat and diagnostic laparoscopy, the indicators of preoperative diagnostics improved [6].

   DM may have a larger luminal diameter than that of the ileum [3]. DM is a true diverticulum consisting of all three layers of the intestinal wall [1]. Heterotopic remnants of the gastric mucosa and pancreatic tissue in DM are observed in 60 and 6% of cases, respectively [4].

   The omphaloenteric or vitelline duct connects the midgut ventrally to provide nutrients during embryonic development. The duct gradually narrows and disappears between the 5th and 8th weeks of pregnancy.

   DM occurs in 2% of the population [4, 7]. The prevalence in men is 3-5 times higher than in women [3]. Only in 2% of cases, DM is manifested by individual symptoms, most often among children aged 2 years [8]. In most cases, DM is diagnosed when complications occur or accidentally during laparotomy or laparoscopy, contrast examination of the intestine. Clinical manifestations in adults are intestinal obstruction and diverticulitis. Painless rectal bleeding is more common in children. With Meckel’s diverticulitis, the symptoms differ little from acute appendicitis.

   Diverticulitis occurs in approximately 20% of patients with DM, more often in the elderly. The complication develops mainly in diverticula with a narrow neck, when food remains accumulate in the lumen, then a bacterial infection joins [9, 10]. Diverticulitis can develop as a result of torsion of the diverticulum and disruption of its blood supply [11].

   Often (about 40% of cases) ulceration of the DM occurs, which, like inflammation, can cause perforation with the development of peritonitis [12].

   Life-threatening complications of DM occur in 4-6% of cases. Intestinal bleeding, peritonitis or intestinal obstruction occurs in 15-30% of patients with symptoms of D.M. Only 6.4% of all complications require surgical treatment, mortality is 2.5–15.0% [8].

   According to A. Johnston and T. Moore [13], the structure of DM complications was as follows: bleeding — 20—30%; intestinal obstruction – 20-25%; diverticulitis – 10-20%; umbilical cord anomalies – less than 10%; neoplasms – 0.5-2.0%.

   Bleeding from a diverticulum is the most common complication among young children, especially in boys under 2 years of age [6]. Symptoms may include bright red discharge (bloody stools), weakness, anemia, and abdominal pain [14].

   Bleeding is caused by ectopia of the gastric mucosa or pancreatic cells in the diverticulum, secretion of hydrochloric acid or alkaline pancreatic juice occurs in these areas, which leads to the formation of ulcers of the ileum mucosa [15]. Mechanical irritation can also cause erosions and ulcers in the diverticulum. Intestinal bleeding occurs relatively rarely and stops spontaneously [16].

   Meckel’s diverticulitis can mimic the clinical picture of acute appendicitis, and perforation of an inflamed diverticulum is dangerous for the development of peritonitis. Sometimes D.M. leads to the occurrence of intestinal obstruction due to the formation of adhesions [17]. In some cases, diverticulitis is accompanied by torsion of the tip of the diverticulum with its mesentery, resulting in inflammation and ischemia [18]. Perforation of the diverticulum can occur due to foreign bodies (fish, chicken bones, seeds of vegetables, fruits) entering its lumen, which can be there for a long time. The lumen can also be obstructed by a tumor, enterolitis, creating conditions for the development of inflammation [1], which also resembles the picture of acute appendicitis.

   Intestinal obstruction, as a complication of DM, is characterized by vomiting, abdominal pain, and stool retention [19]. Remnants of the vitelline duct, which connects the diverticulum to the umbilicus, can create conditions for intestinal volvulus in this area and cause blockage of the intestinal lumen. When DM gets into the inguinal hernia and its infringement, acute intestinal obstruction develops (Littre hernia). Tumors (adenocarcinoma) arising from the mucous membrane of the DM can also lead to obstruction, as well as stones formed in the lumen of the diverticulum, with foreign bodies entering the ileum, tumors initiate the development of inflammation or intussusception of the intestine [1, 13].

   Abnormalities arising from DM include fibrous bands, cysts, fistulas [17], which in turn cause infection, irritation of the skin of the navel, and the formation of an abscess of the abdominal wall. Fibrous bands increase the risk of torsion and strangulation in the internal hernia.

   DM tumors can cause bleeding, acute abdominal pain, intestinal obstruction, perforation, intussusception [17]. Benign tumors of DM: leiomyoma, lipoma, vascular, neuromuscular hamartoma; malignant: the most common form is carcinoid (44%), leiomyosarcoma, gastrointestinal stromal tumors (35%), adenocarcinoma (16%).

   Other complications of DM include small (daughter) diverticula, stones, phytobezoars, vesicodiverticular fistulas (fistula into the bladder) [13].

   DM is the most common cause of lower intestinal bleeding in children [20, 21]. Cases of massive bleeding in DM torsion have been described [22], including 19 cases in 1978–2005.

   The pathogenetic role of Helicobacter pylori in the development of bleeding from ectopic gastric mucosa in DM is discussed [23, 24], a certain role of NSAIDs is assumed [25]. Bleeding from DM can lead to iron deficiency anemia [26]. Perhaps the development of pernicious anemia due to vitamin B 9 deficiency0147 12 due to congestion and dilatation in the ileum.

   According to T. Klinvimol et al. [27], of 1489 patients, only 0.27% had bleeding, according to other authors, they were in 5% of 260 patients [28]. It is assumed that an additional cause of bleeding is mechanical irritation of the ectopic gastric mucosa not only at the base of the diverticulum, but also in its body, as well as fibrosis of the submucosal layer [15].

   Acute intestinal obstruction may be due to incarceration of the DM in the inguinal or femoral hernia (Littre’s hernia), mainly on the right side, a rather rare complication [29, thirty].

   A case of DM infringement in a congenital defect in the mesocolon in the right subphrenic space in a 45-year-old patient is described [30]. The patient had a clinical picture of intestinal obstruction, computed tomography revealed a segment of the small intestine with DM in the right subdiaphragmatic space with a paracolic location, the diagnosis was confirmed during surgery.

   In the literature, there is an observation of DM invagination into its own lumen in a 23-year-old patient [31], which was established by ultrasound and CT, and the diagnosis was confirmed by laparotomy. Microscopic examination of DM revealed ectopic tissues of the mucous membrane of the stomach and pancreas. The patient underwent segmental resection of the intestine.

   In rare cases, DM is located on the mesenteric border of the ileum [32].

   A case of ileocecal and small-intestinal intussusception of Meckel’s diverticulum in a 7-month-old child [33], as well as a case of intestinal intussusception caused by the stump of a removed DM [34], is described.

   In 50% DM contains heterotopic tissues of the stomach, pancreas, jejunum, duodenum and colon, hepatobiliary tissues [31, 35]. Clinically, ectopia may not manifest itself and is detected at autopsy or surgical intervention, a picture of peptic ulcer, appendicitis and Crohn’s disease may occur.

   A case of DM stromal tumor (GIST) has been described [36], a total of 4 such cases have been described [37]. Approximately 3% of neoplasms are detected – benign (lipoma, hamartoma) or malignant (adenocarcinoma), which are manifested by intestinal obstruction, perforation or bleeding [9].

   In most individuals, DM is asymptomatic, in the literature this course is called “silent” [38]. Symptoms usually appear before the age of 2 years. The most common symptoms are painless bleeding from the rectum, melena, sometimes intestinal obstruction, intestinal volvulus, intussusception. Often D.M. shows all signs of acute appendicitis. Severe pain in the epigastric region is accompanied by bloating, more in the epigastrium and umbilical region. The symptoms can be extremely distressing. In some cases, bleeding occurs suddenly and stops spontaneously. Mistakes in diagnosis are often made due to the ambiguity of the combination of other symptoms of the disease with constipation or, conversely, its absence.

   In clinical practice, most researchers distinguish a triad of symptoms: abdominal pain, intestinal bleeding and intestinal obstruction, the prevalence and severity of each of which depends on the anatomical features of the DM, the presence of various ectopic tissues in its wall, the age of patients and their physiological characteristics [ 2].

   Symptoms of DM usually indicate a complication. The most common complications are bleeding (40%), intestinal obstruction (30%), diverticulitis (20%), and diverticulum perforation (10%) [26, 39].].

   Bleeding presents with painless bloody discharge in the form of melena, sometimes “raspberry jelly”, most often at the age of 2 years. The pathogenesis of bleeding is associated with peptic ulceration due to exposure to hydrochloric acid of the ectopic gastric mucosa. The ileum, unlike the stomach, does not have protective properties against hydrochloric acid, which leads to ulceration.

   I.V. Goremykin et al. [40] described 113 children with pathology of the vitelline duct, in 98 including D.M. Among the complications of DM, intestinal obstruction was in 32 children, diverticulitis in 30 children, and peptic ulcer in 24 children. 3 children under the age of 1 year died. In general, serious complications were noted in 75 children: diverticulum gangrene in 14, perforation in 16, peritonitis in 28, bleeding in 17 children. Resection of the intestine carrying the diverticulum and wedge-shaped resection of the diverticulum were more often performed, less often diverticulectomy by the purse-string method and even more rarely open resection of the diverticulum.

   I.V. Poddubny et al. [41] report the results of treatment of 124 children with DM, 65. 4% of them are boys, 52.2% of children were hospitalized for emergency reasons. Diagnostic laparoscopy in all cases made it possible to establish the diagnosis. Laparoscopic diverticulectomy was performed, in 5 children – laparoscopically-assisted resection of a section of the small intestine. There were no serious complications or deaths.

   A multicenter study showed that of 1132 patients with DM, 46% developed intussusception and 24% developed intestinal volvulus [42].

   An analysis is given of 57 children with DM, 40 of whom were operated on [43], 26 had acute diverticulitis, 15 had intestinal obstruction, and 10 had intestinal bleeding. Among the patients there were 43 boys, 14 girls. Histopathological examination revealed ectopia of the gastric mucosa in 9 cases, remnants of the vitelline duct in 64 cases, diverticulitis in 24 cases, and DM ulcer in 14 cases.

   In the diagnosis of DM, scanning of the diverticulum with technetium-99m (sodium pertechnetate) is used; in children, this study is considered the method of choice, the “gold standard” [44]. When scanning, an ectopic gastric mucosa is detected; in about 50% of patients with symptoms of DM, this formation or pancreatic tissue cells are detected [45], presented as spots on the scan, located at a distance from the contours of the stomach. In children, this scanning method, non-invasive and accurate, has 95% specificity and 85% sensitivity [1], accuracy reaches 90% [46, 47]. In adults, the diagnostic value of this method is lower – specificity 9% and sensitivity 62% [48], accuracy 46% [49]. The method is based on the tracer tendency of the isotope to accumulate in the ectopic gastric mucosa in DM.

   DM carriers with ectopic gastric cells may develop peptic ulcers. For diagnosis, especially differential diagnosis, patients should undergo colonoscopy and other tests used for bleeding. Angiography helps in determining the location and intensity of bleeding, ultrasound shows the remains of the vitelline duct or its cysts [50], CT can reveal a blindly ending and inflamed structure in the middle part of the abdominal cavity [1].

   Asymptomatic DM is usually an incidental finding during laparoscopy or laparotomy.

   Laparoscopy is an informative and accurate method of examination, especially with negative results of scintigraphy and ongoing bleeding [51]. Ultrasound is informative in 50% of children with symptoms of DM [17]. To diagnose bleeding from MD, magnetic resonance enterography was used after unsuccessful intestinoscopy [52].

   Based on a study of 14 adult patients with complicated DM, CT was shown to be able to diagnose mechanical ileus, diverticulitis and peridiverticular abscess, as well as pneumoperitoneum [53].

   In the absence of a history of intestinal bleeding, preoperative diagnosis of DM is difficult. Based on a survey of 776 patients, it was found that the correct preoperative diagnosis was made in 88% with a history of intestinal bleeding and only in 11% without bleeding [54]. In doubtful cases, laparoscopy is the preferred diagnostic procedure [55].

   Angiography is not informative and, except in cases of profuse intestinal bleeding, is likely to be negative, especially if the bleeding rate is less than 0. 5 ml/min.

   Treatment of DM is surgical, mainly by video-laparoscopic method [1]. In patients with bleeding, strangulation, perforation, or obstruction of the intestine, surgical treatment involves the removal of the DM along with the adjacent segment of the intestine, this procedure is referred to as a “minor” bowel resection [1]. In patients without the above complications, surgical treatment involves only removal of the diverticulum (“simple diverticulectomy”).

   With regard to asymptomatic DM, some authors recommend to perform revision of the ileum and diverticulectomy in each case of surgical interventions for acute appendicitis to avoid secondary complications of DM [56]. Diverticulectomy is the method of choice for complicated forms of DM.

   In complicated forms of acute appendicitis, an incidental DM should be left, and in uncomplicated appendicitis, an intact DM should be removed [57]. Other authors recommend removing the diverticulum when it is detected in all cases [58].

   In surgical treatment, it is recommended to use the following approaches [17]: laparoscopic diverticulectomy is indicated for a narrow base of the diverticulum, performed similarly to appendectomy; wedge resection of the diverticulum is indicated with full confidence in the absence of ectopic gastric mucosa on the basis of the diverticulum and ileal mucosa; resection of the ileum with a diverticulum is performed for bleeding, intestinal obstruction and perforation.

   The vast majority of patients underwent partial resection of the small intestine with a diverticulum, less often diverticulectomy [53].

   According to J. Sagar et al. [6], the method of choice for the treatment of DM is the removal of the diverticulum by diverticulectomy or segmental resection of the intestine and the imposition of anastomosis, especially when ectopic tissue is found in the area of ​​the diverticulum-intestinal junction, with intestinal ischemia or its perforation.

   Discussions continue regarding the validity of performing a diverticulectomy in case of incidental detection of asymptomatic D. M. During the operation, it is impossible to establish visually or by palpation the likelihood of developing complications D.M. It is proposed to take into account statistically significant risk factors, such as male sex younger than 40 years, a diverticulum longer than 2 cm, the presence of ectopic tissue in the diverticulum [59].

   Some authors propose the removal of an incidentally discovered asymptomatic DM in men younger than 50 years, with a DM length of more than 2 cm and the presence of ectopic tissue [60]. According to P. Stone et al., an accidentally detected asymptomatic DM should not be removed [61], other authors recommend removing DM: in symptomatic forms; in children under 8 years of age; in asymptomatic forms [26]. In case of gangrene or perforation of the appendix, it is proposed to leave the DM in place, only in case of superficial appendicitis, perform diverticulectomy [57].

   Taking into account the life-threatening risk of complications in case of accidental resection of the DM, which is 4. 2 and 9.0% of the development of surgical complications, “associated” diverticulectomy is not considered reasonable [62]. However, many authors do not agree with such statistics and insist that postoperative complications after accidental resections of the DM do not always occur and reach only 6% [6].

   Laparoscopic interventions were used for perforated Meckel’s diverticulitis, including 11 men and 4 women, the average age of which is 38 years (from 21 to 68 years) [63]. All patients had sudden onset abdominal pain, 9- history of bloody stools and/or chronic recurrent abdominal pain. In 2 patients perforation of the DM was diagnosed before surgery, in 4 patients it was suspected, in 9 patients acute perforated appendicitis was suspected. All 15 patients underwent diagnostic laparoscopy. Four patients with a wide base of the DM (≥2 cm) and 2 patients with a diverticulum less than 2 cm in diameter underwent laparoscopic-assisted resection of the ileum, the other 9 patients with a narrow base of the diverticulum (<2 cm) underwent laparoscopic intra-abdominal wedge resection of D. M. The average duration of treatment in a hospital was 4 days; histopathological examination revealed heterotopia of the gastric mucosa in 10 (66.7%) cases. There were no complications or deaths.

   The results of laparoscopic interventions for DM in 19 children [55], among which there were 15 boys and 4 girls, with an average age of 5.4 years, are presented. After laparoscopy, a complete study and surgical treatment was performed extracorporeally after the exteriorization of the intestine with a diverticulum through the umbilicus. 15 children had painless intestinal bleeding, 4 had recurrent abdominal pain. Resection of the intestine with anastomosis was performed in 14 children, 4 – wedge resection of the diverticulum, 1 – diverticulectomy. No conversion was required in any of the cases. The average duration of operations was 75 minutes (from 40 to 155 minutes), there were no serious complications. The mean hospital stay was 5–7 days (4–13 days). The authors believe that transumbilical diverticulectomy is safe and effective in the treatment of DM and provides good results.