RIGHT-SIDED PERFORATED ASCENDING COLONIC DIVERTICULUM MIMICKING ACUTE APPENDICITIS

Acta Inform Med. 2012 Dec; 20(4): 269–270.

Clinic of Anaestesiology, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Corresponding author: Edina Bilic-Komarica, MD, Msc. Clinic for Aaestesiology, CCUS, 71000 Sarajevo, B&H. E-mail: moc.liamg@cilibe

Received 2012 Sep 15; Accepted 2012 Nov 30.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been cited by other articles in PMC.

Abstract

Perforation of the colonic diverticulum is a common reason for emergency laparotomy, especially in older people but is rare in the younger population. While perforation of the sigmoid diverticulum is very common, perforation of the ascending colonic diverticulum is a very rare event. For this reason, the divereticulitis is usually discovered unexpectedly at surgery for suspected appendicitis.

Key words: Righ-sided diverticulitis, perforation, laparotomy, surgery.

1. INTRODUCTION

Right-sided colonic diverticulitis is considered to be a rare condition (1). Most cases of colon diverticulosis is related to the sigmoid colon (2) and it is clear that the correct preoperative diagnosis of right-sided colonic diverticulitis has rarely been made. In clinical practice, one of the great mimics of acute appendicitis has been righ-sided colonic diverticulitis (3). In fact, the diverticulitis with its complications due to the inflammation and perforation is usually discovered unexpectedly at surgery for suspected appendicitis (4). We present a case of a right-sided diverticular disease complicated by perforation of ascendenting colon diverticula in causasians middleaged woman successfully treated surgically.

2. CASE REPORT

A 44-year-old white woman was admitted to the Emergency Department with complaints of right lower abdominal pain, nausea and vomiting for 2 days. Significant findings included local rebound tenderness and palpable fullness over the ileocecal region, leukocytosis, lowgrade fever, and ultrasonographic evidence of acute appendicitis. The blood results were as follows: pH was xx with a base excess of XX, sodium was 142 mmol/L; potassium was 3.1 mmol/L; haemoglobin was 129 g/dL; white cell count was 14.8 x 109/L, liver function were normal.

She was previously healthy and had no significant past medical history. A provisional diagnosis of acute appendicitis was made. At operation, through a Mc Burney incision, the appendix was found to be normal but a 3 cm gangrenous and perforated ascending colonic diverticulum was found. The patient underwent an appendectomy with isolated diverticulectomy and recovered uneventfully.

3. DISCUSSION

Diverticular disease is a common disorder in Western countries (5). Diverticula can occur throughout the colon but are most common near the end of the left colon referred to as the sigmoid colon in Western countries. On the other hand, in Asia the diverticula occur mostly on the right side of the colon (5). The etiology of diverticular disease is multifactorial and not completely understood but it is now known that low dietary fiber intake, cigarette smoking, alcohol intake, corticosteroids, altered collagen structure in the bowel, increased acetylcholine activity in the sigmoid colon, and aging may be risk factors (6, 7). Approximately 75% of patients remain symptom-free during their lifetime. The remaining 25% of patients develop complications in the form of infection (diverticulitis), rectal bleeding, constipation, diarrhea, abdominal cramps, and even colonic obstruction (7). Diverticula localized to the right colon occur at a rate of 6.6 to 14% (10). On the basis of etiologic and pathologic features, two types of diverticula have been described in the right colon: multiple diverticula and solitary diverticulum of the cecum (8, 10).

The most common clinical presentation of right-sided colonic diverticula is an acute inflammatory complication which is difficult to distinguish from other causes of right iliac fossa pain (9). Preoperative diagnosis of appendicitis is almost always made in these patients (10). Other pathology may mimic right side diverticulitis including colonic malignancy, inflammatory Crohn’s mass, perforated foreign body reaction or ileocaecal tuberculosis.

Ultrasound has been evaluated in the diagnosis of right-sided diverticulitis and demonstrated a sensitivity of 91.3%, a specificity of 99.8% and overall accuracy of 99.5% in the diagnosis of righ-sided diverticulitis (11). (Figure ). However, although ultrasound is non-invasive and widely available, operator dependency may limit its accuracy, especially in Western countries where experience of caecal and ascending diverticulitis is limited. In our case, because of our strong clinical assumption that our patient had acute appendicitis no further pre-operative imaging studies were performed. Surgical resection varies from isolated diverticulectomy, ileocaecal resection and right hemicolectomy (12). In our case, isolated diverticulectomy with appendectomy was the method of choice of surgical treatment with good outcome.

Ultrasound examination of right-sided perforated ascending colonic diverticulum Mimicking acute appendicitis.

In conclusion, preoperative diagnosis of right-sided colonic diverticulitis is important in the timely evaluation of treatment modalities, but not always possible. Although ultrasound is non-invasive and widely available, operator dependency may limit its accuracy, especially in Western countries where experience of caecal and ascending diverticulitis is limited. During the surgical procedure, if the diagnosis of acute appendicitis is in doubt, further exploration should be performed. In most cases, when it excludes other possible pathologies, isolated diverticulectomy is adequate treatment.

Conflict of interest

None declared.

REFERENCES

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Characteristics of predominantly right-sided colonic diverticulitis without need for colectomy | BMC Surgery

The etiology of colonic diverticulum is currently unknown and this condition generally produces no clinical symptoms. In the United States, 4% of patients have clinical symptoms, and 15% have complicated disease [1]. In Europe and the Americas, the incidence of acute left-sided colonic diverticulitis (ALCD) is higher, while acute right-sided colonic diverticulitis (ARCD) is relatively rare, and ALCD is more common in the elderly [2]. Through a retrospective analysis of colonic diverticulitis in our hospital, we found that ARCD is more common in our patients and identified more often in males, while ALCD is rare. The onset age of ARCD in our population is younger when compared to patients in Europe and the United States. This is consistent with other reports from China [3, 4].

Because the most common type of colonic diverticulitis varies greatly in different regions of the world, there are also differences in clinical manifestations and treatment plans. Caecal and ascending colonic diverticulitis predominate in China; especially diverticulitis near the ileocecum which produces clinical symptoms similar to acute appendicitis including metastatic right lower abdominal pain, right lower abdominal fixed tenderness, and disease progression, etc. [3]. Our hospital prefers non-surgical treatment for ARED, and this conservative approach proves worthy. However, 24.6% of ARCD cases underwent invasive treatment, mainly because ARCD could not be distinguished from acute appendicitis. While all patients underwent CT examination of the abdomen prior to surgery, even experienced doctors can misdiagnose CT images. When we carefully re-analyzed the abdominal CT images after surgery, we found that it was possible to distinguish between ARCD and acute appendicitis. However, ARCD is usually characterized by acute abdominal pain, so it is difficult to rapidly diagnose before surgery. According to the WESE guidelines, ultrasonography is the imaging modality of choice for ARCD because usually patients are younger and CT imaging poses the risk of exposure to radiation [2]. Cases from our hospital support this author’s belief that CT provides advantages over ultrasound when distinguishing acute appendicitis and ARCD. The most common cause of acute abdominal pain in Chinese hospitals is acute appendicitis. Misdiagnosis of an ultrasound may result in emergency surgery. However, we assert that most cases of ARCD do not require surgical treatment, and that abdominal CT can exclude incorrect diagnoses.

Compared with acute appendicitis, we have found that the clinical symptoms of ARCD were milder, and began to resolve more rapidly after treatment. Timely and effective treatment only rarely leads to diffuse peritonitis or intestinal leakage, which inevitably cause surgeons to mistakenly think that ARCD is mild. However, in a number of surgical exploration cases, we found that the ARCD had suppurated and perforated. The affected area was partially wrapped by the greater omentum, so the clinical symptoms were mild. As mentioned earlier, the patient underwent emergency surgery because of a misdiagnosis of acute appendicitis without severe clinical symptoms. Therefore, we suspect that more patients with suppuration and perforation may be found in the non-surgical treatment group. We also found that, preoperatively, it was difficult to accurately assess whether the ARCD was perforated using CT images. A higher percentage of grade II cases were identified in the surgical group, despite a preoperative CT assessment of grade I. CT imaging appears insufficient for accurately assessing Hinchey’s classification of ARCD. The Chinese literature provides many cases of colonic diverticulum perforation, most commonly occurring in the sigmoid colon [5, 6]. This may be due to the protection offered by the greater omentum. ARCD may have been wrapped with the greater omentum before suppuration and perforation. The sigmoid colon is not easily wrapped by the omentum, and patients with sigmoid diverticulitis are generally older.

ARCD is often accompanied by increases in inflammation indicators. Some patients with mild symptoms may have a normal inflammation index. The sensitivity of CRP is relatively high, while the sensitivity of WBC is relatively low. If the inflammation index is not high, the patient can recover quickly without special treatment. MÄKELÄ et al. published a study showing that CRP > 150 mg/L is an independent risk factor for colonic diverticulitis [7]. In our study, the proportion of patients with CRP > 150 mg/L was relatively low. Simultaneously, there was no significant increase in CRP at early stages, and this value did not play an important reference role in treatment decisions. However, the CRP index is an important reference value for predicting treatment outcome. CT imaging can quickly and effectively evaluate the severity of diverticulitis, and patients with limited inflammation usually recover better.

No significant difference in patient outcome was observed between our three treatment groups. However, the conservative, non-surgical treatment was much less expensive. Therefore, we recommend a more conservative treatment approach, which is also consistent with the results of other studies [1]. At present, the most commonly used surgical method is colectomy, but that surgery produces significant trauma [8,9,10]. Currently, there are no detailed guidelines for the treatment of ARCD. In China, colonic diverticulitis often occurs in the cecum and ascending colon. Right hemicolectomy may be required [11, 12]. Most of the cases in our hospital underwent resection and repair of colonic diverticulum or abdominal drainage. Post surgery, there was no intestinal leakage, and the postoperative recurrence rate was low. Colectomy is not recommended for uncomplicated diverticulitis. Is it feasible to repair acute complicated diverticulitis? We lack enough patients with complicated diverticulitis to study the feasibility of diverticulectomy and repair of sigmoid diverticulitis. In our hospital, only one patient with uncomplicated sigmoid diverticulitis underwent diverticulum resection, and did not experience intestinal leakage following surgery.

In our research, we found that the rate of recurrence of ARCD was low with relapse usually occurring relapsed within the first year. Colonoscopy is not recommended during hospitalization because it may aggravate the condition. Colonoscopy is routinely recommended 2–3 months after discharge; however some patients did not undergo colonoscopy. In China, a high proportion of younger people with ARCD refused colonoscopy.

Right-sided acute diverticulitis: A single Western center experience

Highlights

•

Right-sided diverticula are usually asymptomatic but complications may occur and in most cases it cannot be distinguished from acute appendicitis.

•

A surgical exploration is performed in most cases and in selected cases diverticulectomy can be a valid option.

Abstract

Introduction

Right sided diverticular disease is a rare condition in Western countries whereas is common amongst Asian population. The aim of this study is to evaluate options and outcomes for the treatment of right colonic diverticulitis.

Method

We included only patients undergoing surgery with right colon diverticulitis (RCD) proven at histological specimen examination from September 2011 to December 2016.

Results

We performed 18 operations for RCD. Age was lower compared to left sided disease (49 ± 16 vs 67 ± 14; P < 0.001). Three patients were Asian (16.7%). RCD was diagnosed preoperatively in 8 cases (44.4%), whereas appendicitis was suspected in 9 cases (50%) and neoplasm in one (5.6%). We performed resection with anastomosis in 13 patients (72.2%) and in 5 cases we performed a diverticulectomy. Laparoscopy was performed in 14 cases (77.8%). Postoperative morbidity occurred in 3 patients (16.7%; grade 2 or 3a according to Clavien-Dindo) with no mortality. No postoperative events occured after diverticulectomy with shorter hospital stay (4 ± 1.5 vs 11 ± 13; P = 0.022), as no recurrence or need for elective surgery after a mean follow-up of 20 months.

Conclusion

RCD is a rare but not irrelevant condition. Minimally invasive surgery is often feasible and complication rate is low. In selected patients, diverticulectomy can be a valid alternative to treat this condition providing improved postoperative results.

Keywords

Right sided diverticular disease

Surgical treatment

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Diverticulitis symptoms can be limited to severe abdomin pain.

Diverticulitis symptoms can be limited to severe. Many people with diverticulitis have little or no discomfort or symptoms.

What is Diverticulitis?

When the small pouches in the colon bulge outward through weak spots, like an inner tube that pokes through weak places in a tire, the pouch is called a diverticulum. Pouches (plural) are called diverticula. The condition of having diverticula is called diverticulosis. When the pouches become infected or inflamed, the condition is then called diverticulitis, and this happens in 10 to 25 percent of all people with diverticulosis. Diverticulosis and diverticulitis are also called diverticular disease.

Diverticulosis of the Colon Often Diagnosed During Colonoscopy

After a colonoscopy many people are surprised to find the have diverticulosis. It is very common since 40 to 60 percent of people have them and they become even more common as you age. The condition is very common and usually don’t cause any problems. Diverticulosis only causes symptoms if one of the diverticula bleeds or gets infected. When bleeding does occur, it tends to be intense for a short period, but usually stops on its own. The cause of the diverticular bleeding may be that  something injured a blood vessel in the pouch. Even if bleeding stops on its own, you can still lose a considerable amount of blood, so you should see one of the doctors at Digestive Care Physicians.

Diverticulitis Symptoms

Signs and symptoms include:

• Pain, which may be constant and persist for several days. The lower left side of the abdomen is the usual site of the pain. Sometimes, however, the right side of the abdomen is more painful, especially in people of Asian descent.
• Nausea and vomiting.
• Fever.
• Abdominal tenderness.
• Constipation or, less commonly, diarrhea.

This information was provided by the Mayo Clinic.

Treating Diverticulitis

The board certified physicians at Digestive Care Physicians based north of Atlanta are skilled at diagnosing and treating mild and severe cases of diverticulitis.

Treatment for diverticulitis focuses on clearing up the infection and inflammation, resting the colon, and preventing or minimizing complications. An attack of diverticulitis without complications may respond to antibiotics within a few days if treated early.

An acute attack with severe pain or severe infection may require a hospital stay with treatment by antibiotics and a liquid diet. In some cases, however, surgery may be necessary.

What Is Diverticulitis? Symptoms, Causes, Diagnosis, Treatment, and Prevention| Everyday Health

Favorite Resources for Patient Information

American Gastroenterological Association (AGA)

The AGA describes itself as a “trusted voice in the gastrointestinal community.” The group’s website is an excellent place to start if you’re looking for general information on diverticulitis. Glean insights on getting tested and potential complications, and download its comprehensive patient info PDF to your phone, tablet, or computer for quick reference at your next doctor’s appointment.

Canadian Society of Intestinal Research (GI Society)

Diverticulitis can have a huge impact on your life, and it’s the GI Society’s aim to make living with this condition easier. Its website offers general information about diverticulitis as well as practical tips, such as managing diverticular disease as a young person. Read advice on recommended fiber intake and physical activity, or check out the Q&A section or videos.

American College of Gastroenterology (ACG)

The ACG is committed to enhancing patient care based on the most recent research available. On its site, you’ll learn about diverticulitis causes, treatment options, prevention, and more. It offers a wealth of multimedia resources, too. This includes podcasts, videos, brochures, and a “Find a Gastroenterologist” search tool.

Favorite Resources for Diet Advice

Mayo Clinic

Not sure what to eat with diverticulitis? While your doctor might give recommendations and tips, it can be difficult to remember everything you’ve heard. No worries — the Mayo Clinic does a superb job highlighting foods that are safe to eat with diverticulitis.

National Institute of Diabetes and Digestive and Kidney Disease (NIDDK)

We can’t talk about diverticular disease without including the NIDDK. Even if you know the benefit of consuming fiber to manage diverticulosis or prevent another episode of diverticulitis, you may not know how much to eat. The NIDDK provides a breakdown of the best fiber-rich foods to consume, as well as how much to eat each day.

For more on how to add more fiber to your diet, check out our article.

Favorite Resource for Telemedicine

Gastroenterology.com

Got a question about diverticulitis? Flares can happen at the most inopportune times, like when your doctor isn’t available or when you can’t get an appointment. Gasteroenterology.com is another place to find answers to your questions. Perhaps the best part? The service is free. Keep in mind that it might take a couple of days for a gastroenterologist to get back to you.

Favorite Site for Online Support

Diverticulitis Support Group

Diverticulitis can be overwhelming and frustrating, so there’s comfort in knowing you’re not alone with this illness. Yet local support isn’t always an option. With an online support group, you can lean on others for diet and medication advice, or simply for emotional support, anytime of the day or night.

Favorite App for Tracking Diverticulitis

Foodility

If you have recurrent diverticulitis flares, monitoring what you eat can help pinpoint certain patterns. Download the Simple Food Tracker Foodility diary and record everything you eat and drink. You may notice trends, such as more attacks after consuming too much red meat and alcohol or when you’ve eaten too few fruits and vegetables. The app is free but only available for iOS devices on the App Store.

Learn More About Online Diverticulitis Resources

Additional reporting by Valencia Higuera, Rena Goldman, Stephanie Bucklin, and Melinda Carstensen.

Diverticular disease – Illnesses & conditions

Treatment options for diverticular disease and diverticulitis depend on how severe your symptoms are.

Diverticular disease

Most cases of diverticular disease can be treated at home.

The over-the-counter painkiller paracetamol is recommended to help relieve your symptoms.

Painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are not recommended because they may upset your stomach and increase your risk of internal bleeding.

Eating a high-fibre diet may initially help to control your symptoms. Some people will notice an improvement after a few days, although it can take around a month to feel the benefits fully. Read more advice about using diet to improve the symptoms of diverticular disease.

If you have constipation, you may be given a bulk-forming laxative. These can cause flatulence (wind) and bloating. Drink plenty of fluids to prevent any obstruction in your digestive system.

Heavy or constant rectal bleeding occurs in about 1 in 20 cases of diverticular disease. This can happen if the blood vessels in your large intestine (colon) are weakened by the diverticula, making them vulnerable to damage. The bleeding is usually painless, but losing too much blood can be potentially serious and may need a blood transfusion.

Signs that you may be experiencing heavy bleeding (aside from the amount of blood) include:

• feeling very dizzy
• mental confusion
• pale clammy skin
• shortness of breath

If you suspect that you (or someone in your care) is experiencing heavy bleeding, seek immediate medical advice. Contact your GP at once. If this is not possible then call NHS 24 111 service or your local out-of-hours service.

Diverticulitis

Treatment at home

Mild diverticulitis can often be treated at home. Your GP will prescribe antibiotics for the infection and you should take paracetamol for the pain. It’s important that you finish the complete course of antibiotics, even if you are feeling better.

Some types of antibiotics used to treat diverticulitis can cause side effects in some people, including vomiting and diarrhoea. 

Your GP may recommend that you stick to a fluid-only diet for a few days until your symptoms improve. This is because trying to digest solid foods may make your symptoms worse. You can gradually introduce solid foods over the next 2 or 3 days.

For the 3 to 4 days of recovery, a low-fibre diet is suggested, until you return to the preventative high-fibre diet. This is to reduce the amount of faeces (poo) your large bowel has to deal with while it is inflamed.

If you have not been diagnosed with diverticular disease before, your GP may refer you for a test such as a colonoscopy or CT colonography after the symptoms have settled.

Treatment at hospital

If you have more severe diverticulitis, you may need to go to hospital, particularly if:

• your pain cannot be controlled using paracetamol
• you are unable to drink enough fluids to keep yourself hydrated
• you are unable to take antibiotics by mouth 
• your general state of health is poor
• you have a weakened immune system
• your GP suspects complications
• your symptoms fail to improve after two days of treatment at home

If you are admitted to hospital for treatment, you are likely to receive injections of antibiotics and be kept hydrated and nourished using an intravenous drip (a tube directly connected to your vein). Most people start to improve within 2 to 3 days.

Surgery

In the past, surgery was recommended as a preventative measure for people who had 2 episodes of diverticulitis as a precaution to prevent complications.

This is no longer the case, as studies have found that in most cases, risks of serious complications from surgery (estimated to be around 1 in 100) usually outweigh the benefits.

However, there are exceptions to this, such as:

• if you have a history of serious complications arising from diverticulitis
• if you have symptoms of diverticular disease from a young age (it is thought the longer you live with diverticular disease, the greater your chances of having a serious complication)
• if you have a weakened immune system or are more vulnerable to infections

If surgery is being considered, discuss both benefits and risks carefully with the doctor in charge of your care.

In rare cases, a severe episode of diverticulitis can only be treated with emergency surgery. This is when a hole (perforation) has developed in the bowel. This is uncommon, but causes very severe abdominal pain, which needs an emergency trip to hospital.

Colectomy

Surgery for diverticulitis involves removing the affected section of your large intestine. This is known as a colectomy. There are 2 ways this operation can be performed:

• an open colectomy – where the surgeon makes a large incision (cut) in your abdomen (stomach) and removes a section of your large intestine
• laparoscopic colectomy – a type of “keyhole surgery” where the surgeon makes a number of small incisions in your abdomen and uses special instruments guided by a camera to remove a section of large intestine

Open colectomies and laparoscopic colectomies are thought equally effective in treating diverticulitis, and have a similar risk of complications. People who have laparoscopic colectomies tend to recover faster and have less pain after the operation.

Emergency surgery when the bowel has perforated is more likely to be open and may result in a stoma being formed (see below).

Stoma surgery (‘having a bag’)

In some cases, the surgeon may decide your large intestine needs to heal before it can be reattached, or that too much of your large intestine has been removed to make reattachment possible.

In such cases, stoma surgery provides a way of removing waste materials from your body without using all of your large intestine. It is known as “having a bag” as a bag is stuck to the skin on your belly and the faeces (poo) are collected in the bag.

Stoma surgery involves the surgeon making a small hole in your abdomen – known as a stoma. There are 2 ways this procedure can be carried out: 

• An ileostomy – where a stoma is made in the right-hand side of your abdomen. Your small intestine is separated from your large intestine and connected to the stoma, and the rest of the large intestine is sealed. You will need to wear a pouch connected to the stoma to collect waste material (poo).
• A colostomy – where a stoma is made in your lower abdomen and a section of your large intestine is removed and connected to the stoma. As with an ileostomy, you will need to wear a pouch to collect waste material.

In most cases, the stoma will be temporary and can be removed once your large intestine has recovered from the surgery. This will depend on the situation when you had the operation. If it was an emergency operation, you may need a few months to recover before having surgery to reverse the stoma.

If a large section of your large intestine is affected by diverticulitis and needs to be removed, or if you have multiple other conditions that make major surgery a risk, you may need a permanent ileostomy or colostomy.

Results of surgery

In general terms, elective (non-emergency) surgery is usually successful, although it does not achieve a complete cure in all cases. Following surgery, an estimated 1 in 12 people will have a recurrence of symptoms of diverticular disease and diverticulitis. 

In an emergency setting, the success rate depends on how unwell you are when you require the operation.

The common condition you may never have heard of: what is diverticulitis and how do you prevent it?

The most noticeable symptom is pain, usually on the lower left side of the abdomen,

Have you ever heard of a diverticula? Did you know that certain age groups have a 50 percent chance of developing diverticulosis?

A diverticula is a small pocket or pouch that forms in the wall of the large intestine or colon. They usually develop when naturally weak places in the colon give way under pressure, causing marble-sized pouches to protrude through the colon wall.

This process is called diverticulosis and for most people, it won’t cause any symptoms or complications.

However, when those diverticulum become infected or inflamed, it becomes known as diverticulitis and can be far more serious and uncomfortable for the person experiencing it.

What are the symptoms of diverticulitis?

The most noticeable symptom is pain, usually on the lower left side of the abdomen, although people of Asian descent are more likely to experience the pain on the right side of the abdomen for reasons we don’t fully understand yet.

Other symptoms include nausea and vomiting, abdominal tenderness, fever, constipation or diarrhea, shivering, and, occasionally, rectal bleeding.

The pain from diverticulitis is constant, lasting for days or until the condition is treated, and is generally sharp and progressive. However, different people will experience different symptoms.

In about one in four cases, people with diverticulitis will experience complications. These can include abscesses which occur when pus collects in the pouch, blockages in the colon, or peritonitis.

Peritonitis occurs when the infected or inflamed pouch ruptures and spills intestinal contents into your abdominal cavity. It is a medical emergency and requires immediate care.

What causes diverticulitis?

There are various risk factors that can increase the likelihood of someone developing diverticulitis. Ageing is the most significant, with the incidence rate increasing significantly as we grow older.

There are a range of general lifestyle factors that can also increase your risk of developing diverticulitis, including obesity, smoking, lack of exercise and a diet high in animal fats and low in fibre.

Finally, certain medications can also increase the risk, so talk to your GP if you’re concerned.

How can I prevent diverticulitis?

The best way to prevent diverticulitis is to focus on eating a healthy diet that’s high in fibre. High fibre foods such as fruits, vegetables and whole grains soften waste and help it pass more quickly through the colon.

How is diverticulitis treated?

Caught early, diverticulitis can be treated with antibiotics, diet and over-the-counter pain medicine. You may also be put on a liquid diet while your bowel heals. If left untreated, diverticulitis can require surgery to remove the infected pouches. If you’re experiencing abdominal pain or other symptoms, visit your GP to get it checked out.

Is there a link to bowel cancer?

There is no proven link between bowel cancer and diverticular disease. However, diverticular disease can make the colon more rigid, which can make the process of diagnosing bowel cancer through colonoscopy more challenging.

90,000 🧬 Diverticular disease of the colon. In simple words

GMS Clinic gastroenterologist Aleksey Golovenko answers frequently asked questions about this disease in his article.

What are diverticula?

A diverticulum is a protrusion of the intestinal wall that resembles a “hernia” on a soccer ball. Most often, diverticula are found in the large intestine – these are the last 1.5 meters of the digestive tube, where water is absorbed, making the stool solid from liquid.Less common are diverticula in the esophagus and small intestine. A person’s gender does not affect whether diverticula appear, but with age, the likelihood of their occurrence increases.

Why do these diverticula appear?

There is no unified theory of the origin of diverticula. Diverticula appear in the “weak” places of the intestinal wall – the places where blood vessels penetrate it. It is also noticed that diverticula appear more often in people with constipation and in residents of Western countries, where the diet is low in dietary fiber – natural “softeners” of stool.Apparently, if, due to a lack of dietary fiber, the stool becomes too dense and moves through the intestine not in one mass, but in solid fragments, in some parts of the colon the pressure in the lumen rises too much. This leads to protrusion of the mucous membrane and submucosa of the intestine towards the abdominal cavity through the muscle layer.

I found diverticula. I am sick?

Most probably not. The mere presence of diverticula (in the absence of symptoms) is called “diverticulosis”.Only every fifth person with diverticula has some manifestations of the disease, and they are not always associated with active inflammation of the diverticula.

Can the stomach ache from diverticula?

Maybe, but there are several reasons for this pain. Intense constant pain over the area of ​​the intestine where the diverticula are located, more often indicates inflammation of the diverticulum – diverticulitis. Inflammation occurs when the orifice of a diverticulum is blocked by a dense piece of stool (coprolite).This disrupts the blood supply to the diverticulum, and also facilitates the movement (translocation) of bacteria from the lumen of the colon into the wall of the diverticulum. Together, this leads to inflammation of the diverticulum, and sometimes to bleeding from it.

Most often, diverticulitis disappears without a trace during antibiotic therapy. In some people, diverticulitis becomes chronic — the inflammation does not go away. This can lead to complications: abscesses (abscesses in the tissue surrounding the diverticulum), fistulas (purulent passages connecting the lumen of the diverticulum, for example, with neighboring organs), infiltration (tumor-like accumulation of cells around the inflamed diverticulum) and stricture (narrowing of the intestinal lumen at the site of inflammation ).However, colon diverticulum pain can occur without inflammation.

How so? There is no inflammation, so where does the pain in the actually healthy intestine come from?

In the thickness of the colon wall, there is a network of nerve fibers that control its motor skills – which segments of the intestine will contract, pushing out the stool. When the pressure in the intestinal lumen rises (passing stool or gas), special cells are activated that release neurotransmitters (for example, serotonin).This signals the nervous system to contract the intestine and empty its contents. Normally, we hardly feel this “work” of the intestine.

When a diverticulum becomes inflamed, the balance of neurotransmitters is disturbed, which is partly facilitated by changes in the composition of bacteria within the diverticulum. An imbalance in neurotransmitters can persist even after the inflammation has passed. This leads to an increase in the sensitivity of the intestine to stretching (doctors call this “visceral hypersensitivity”).This phenomenon is confirmed by experiments. If a healthy person and a patient with diverticular disease are introduced into the intestine and begin to smoothly inflate it with air, then a person with a disease will experience discomfort earlier than a healthy person (that is, pain will occur with a smaller volume of the balloon). The same pain mechanism has been described in irritable bowel syndrome.

How do you determine if there is inflammation and other complications?

Computed tomography is the best test for suspected diverticulum inflammation.In this study, several emitters rotate around the human body and numerous X-ray images are obtained. Then a computer program uses these fragments to create integral “slices” of the body. Tomography allows you not only to see changes in the contour of the intestinal wall (that is, the actual diverticula), but also changes in the tissues surrounding the colon (for example, abscesses). A less accurate way to find diverticula is an irrigoscopy or, in a simpler way, an enema with barium sulfate, which is clearly visible in X-rays and allows you to see the inner contour of the intestine and some very gross complications (for example, strictures).

Instead of computed tomography, some centers use ultrasound (ultrasound), which, unlike tomography, is completely safe and, apparently (in experienced hands), has almost the same accuracy. The downside is that an ultrasound specialist must undergo special long-term training in order to learn how to diagnose diverticula, so such doctors, alas, are not in every clinic.

What about colonoscopy?

Colonoscopy – that is, examining the colon using a flexible camera with a video camera – is also a way to detect diverticula.Most diverticula are discovered by accident during routine colonoscopy, which is done for early detection of cancer. However, if acute inflammation of the diverticulum (diverticulitis) is suspected, colonoscopy is not used as the first line of diagnosis. During colonoscopy, the intestine is inflated from the inside with gas, and this can lead to perforation (rupture) of the diverticulum.

At the same time, after the inflammation of the diverticulum has passed, a colonoscopy should be performed without fail.Research shows that colon cancer is more likely to be found within the first year after acute diverticulitis. Apparently, inflammation in some patients “masks” the tumor on X-ray images, and it is both unsafe and impossible because of pain to see the entire colon with an endoscope during acute inflammation.

Can you protect yourself from diverticulitis and other complications?

Yes, if you have diverticula, you can reduce your risk of inflammation by having a soft stool emptying your bowels every day.Stool consistency is most influenced by the fiber content. Try to eat at least a plate or cup of vegetables and fruits every day, add wheat bran to porridge and yogurt, and drink at least a glass of liquid (not necessarily water) with each meal. Eating dried fruit instead of candy and other sweets can also help keep your weight in check.

It happens that gas production increases from a plentiful intake of plant foods. Then, to normalize the stool, they take balanced dietary fibers that are not so strongly fermented by bacteria, for example, psyllium is a psyllium seed husk that can be consumed indefinitely.By the way, vegetarians who, refusing meat, begin to consume more plant foods, and the diverticula themselves, and their complications, occur less frequently than non-vegetarians.

They say you can’t eat seeds and popcorn – it’s all stuck in diverticula.

This is an old theory that has been completely refuted by modern research. American scientists have observed 47,000 people who, during a routine examination at the age of 40 to 75, did not reveal any diseases of the colon, as well as diverticula.For 18 years, participants filled out questionnaires about their condition and talked about their diet every 2 years for 18 years. It turned out that diverticulitis and bleeding from diverticula occurred with the same frequency in people who do not eat nuts, popcorn and seeds, and in those who eat well. Moreover, those who took nuts twice a week not only not more often, but less often ended up with doctors for diverticulitis than people who consumed nuts only once a month.

I was diagnosed with uncomplicated diverticular disease with clinical manifestations.The stomach on the left hurts, and the doctors do not find inflammation. Is it being treated?

Yes, because of similar pain mechanisms, treating uncomplicated diverticular disease is similar to treating irritable bowel syndrome. Pain is eliminated by taking antispasmodics – drugs that relieve painful contraction of the intestine, which are often taken for a long time. A non-absorbable (non-absorbable) antibiotic is sometimes prescribed to change the composition of bacteria in the gut. Some patients may need a small dose of antidepressants to improve the metabolism of serotonin, which regulates gut motility.

I see, what if it hurts today not from inflammation, but tomorrow – diverticulitis and peritonitis? When to go to the doctor?

It is necessary to consult a doctor if the pain has sharply increased and has become constant, does not go away at night, and also if the body temperature rises, chills, nausea or vomiting appear, or fainting occurs. You should also always consult your doctor if there is blood in your stool. It is very important. Without timely treatment, diverticulitis can result in surgery.And even worse.

Diverticular disease – symptoms, modern methods of diagnosis and treatment

Diverticular disease (diverticulosis) of the colon is a sequence of anatomical and pathophysiological changes associated with the presence of diverticula (diverticulum is a sac or reservoir in the wall of any hollow organ, in this case, the intestine). These changes most often occur in the sigmoid colon, but can also affect the entire colon, ranging from the presence of a single diverticulum to multiple diverticula (to the point that it will be difficult to count them).

It was found that the risk of developing diverticular disease reaches 5% at the age of 40 years and can rise to 80% by the age of 80 years.

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Symptoms

Patients with acute diverticulitis usually complain of pain in the left lower quadrant of the abdomen. However, patients with an elongated sigmoid colon and its inflamed segment may have pain in the right iliac region, which is “disguised” as acute appendicitis.The pain is mostly constant, not colicky. Irradiation can be in the back, side on the same side, groin and even in the leg. Pain may be preceded or accompanied by an episode of constipation or diarrhea. Most of the pain is progressive (unless treatment is applied).

Complications

A complication of diverticulosis is acute diverticulitis.

Diagnostics

For diagnostics, the following can be used:

• an overview image of the abdominal cavity, which is made in the patient’s position standing on the right or in the position on the left side.

• computed tomography, which is the diagnostic method of choice for acute abdominal pain (for this reason, plain abdominal radiographs are rarely used). A great advantage of CT examination is the ability to document diverticulitis, even uncomplicated ones, when the clinical diagnosis is in doubt.

• magnetic resonance colonography.The method gives results that coincide with the data of computed tomography, in the absence of patient irradiation.

• colonoscopy – used with caution (usually endoscopic examination is postponed until the symptoms of acute inflammation disappear.

Treatment

The initial treatment for asymptomatic diverticular disease consists of diet.The purpose of dietary manipulations is to increase the volume of feces and thereby increase the lumen of the intestine, reduce the transit time and decrease the intra-luminal pressure.

The diet is generally slag-free or simply liquid throughout the acute phase until the acute symptoms subside. Then an increase in the amount of fiber in the food should be prescribed.

If general symptoms are noted, then the patient should be hospitalized for more intensive care.Signs of a more serious spread of the disease are: severe leukocytosis, high fever, tachycardia, or hypotension, as well as data from a physical examination, indicating the spread of the disease inside the abdominal cavity, requiring hospital treatment. Treatment involves intravenous antibiotics. Patients should not drink until signs of clinical improvement appear.

Symptoms should improve within 24 to 48 hours. If absent, surgery is required.

Operations

In an emergency situation requiring surgical intervention, a simple disconnection with the removal of feces from the damaged segment of the colon, disconnection with suturing of the perforation site, obstructive resection (Hartmann’s operation) or with a mucous fistula (Mikulich’s operation) can be used. Additional activities include performing a thorough abdominal lavage on the operating table.

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Advantages of the Hospital Center

Individual treatment regimen for each patient

For each patient, without fail, even at the prehospital stage, an individual treatment regimen is developed, taking into account all the characteristics of the body: age, health status, medical history, etc.- this approach allows you to minimize risks both during the operation and in the postoperative period, and as a result, to ensure the fastest possible rehabilitation with a minimum period of hospitalization.

Multidisciplinary approach

The medical staff of the Hospital Center is a single team made up of doctors – experts of different specializations, which allows for a multidisciplinary approach.We treat a patient, seeing in front of us not a list of the diseases he has, but a person whose problems are interrelated and interdependent. The therapeutic measures taken are always aimed at improving the overall health, well-being and quality of life of the patient, and are not limited to eliminating the symptoms of a specific disease.

Surgical treatment of any level of complexity

The operating doctors of the Hospital Center possess advanced and high-tech methods of performing operations.The combination of highly qualified doctors and innovative equipment allows for surgical treatment of the highest level of complexity.

High-tech, minimally invasive treatment methods

The basis of the methodology of treatment carried out in the Hospital Center is the principles of minimizing risks for the patient and the fastest possible rehabilitation.

Implementation of such an approach is possible only with the use of the most high-tech techniques, modern equipment and the use of the latest achievements of medical science.

The qualification of doctors in combination with modern equipment allows us to successfully implement this approach to treatment.

Fast-track surgery

Fast-track is a comprehensive technique that allows you to minimize the patient’s stay in the hospital without compromising the quality of treatment.

The approach is based on minimizing surgical trauma, reducing the risk of postoperative complications and accelerating recovery from surgery, which ensures our patients have a minimum hospital stay.

Even such complex operations as, for example, cholecystectomy, thanks to this approach, require a hospital stay of no more than 3 days.

Personal medical supervision in the postoperative period

To completely exclude the development of possible complications, the early postoperative period, all patients, regardless of the complexity of the operation, are carried out in the intensive care unit under the individual supervision of an intensive care physician.

Transfer of the patient to the ward is carried out only in the absence of even the smallest possible risks.

Informing relatives 24/7

We are as open as possible and take care not only of the patient, but also of his loved ones. Patient health information is provided to relatives seven days a week, 24 hours a day.

Visiting patients is also possible at any convenient time.

Highly comfortable single and double rooms

At the service of patients are spacious comfortable single and double rooms equipped with everything necessary for rest and recovery.

In the pediatric department, our little patients are accommodated together with their parents.

Tax deduction

According to the tax legislation of the Russian Federation, each patient has the right to compensation up to 13% of the amount spent by him on his treatment, as well as the treatment of close relatives.

Our specialists will prepare for you a package of documents for the tax office for a refund of 13% of the cost of treatment, as well as give recommendations on various ways of interacting with the tax office.

Contacts

+7 (499) 583-86-76

Moscow, Bakuninskaya street, building 1-3
Nearest metro station: Baumanskaya

90,000 symptoms, diagnosis, treatment of diverticulitis – Department of the State Hospital of the Central Clinical Hospital of the Russian Academy of Sciences

Intestinal diverticulosis is a protrusion of the walls in the form of formations on the mucous surface of diverticula.More common in older adults. Cases of illness in people under 30 years old and in children are extremely rare. Pathology can be congenital.

Reasons for development

If there is not enough fiber in a person’s diet, physical activity slows down. Constipation and bloating occur, and intraintestinal pressure increases. As a result, protrusions (diverticula) form in the walls. The disease is promoted by muscle weakness, which can be the result of inflammation or injury.Often, weak muscles provoke congenital diverticulosis of the large intestine. Diverticulosis of the sigmoid colon can result from disturbances in intestinal motility.

Risk factors for the development of pathology

• Frequent constipation;
• An improperly formulated diet with an excessive amount of refined foods;
• Genetic predisposition;
• Circulatory disorders;
• Advanced age.

Diverticulosis symptoms

The uncomplicated form of the disease is accompanied by the following manifestations:

• Painful cramps – left or below, in the middle of the abdomen, sharp or aching;
• After eating, the pain intensifies, but after a while it goes away on its own;
• If the protrusion is in the sigmoid colon, the pain may be similar to appendicitis;
• Possible spread of pain in the anus, sacrum and lower back, on the buttocks and groin;
• Pain stops after bowel movement or gas passes.

The disease is accompanied by the following symptoms:

• Chronic constipation, which may be followed by diarrhea;
• Much mucus is secreted from the anus;
• The person has a false urge to defecate;
• Offensive gas, bloating;
• After defecation, there is a feeling of incomplete emptying of the intestines.

Diverticulosis can be asymptomatic for a long time, but in some cases an inflammatory process develops.In this case, complications are possible:

• Intestinal obstruction;
• Internal bleeding;
• Accumulation of infiltrate;
• Fistulas inside and outside;
• Perforation – with perforation, purulent processes are possible.

Diagnostics

The diagnosis is based on examination data, patient complaints and the results of diagnostic procedures:

Which doctor should I contact

Diverticulosis is a gastrointestinal disease, and a gastroenterologist is most often treated.The primary task of the doctor is:

• Exclusion of diagnoses with similar symptoms;
• Survey appointments;
• Defining a strategic approach to treatment.

In the course of treatment, you may need to consult other specialists: a proctologist, surgeon, therapist, pediatrician and geriatrician, endoscopist and nutritionist.

Treatment

How to treat diverticulosis is determined individually in each case.If the symptoms are not expressed, treatment is not required – it is enough to adjust the diet.

Treatment for uncomplicated diverticulosis includes:

• Use of antimicrobials and enzymes to improve digestion;
• Laxatives;
• Antispasmodics.

Treatment is carried out on an outpatient basis. In acute and complicated course of the disease, if in the first 3-4 days the effectiveness of treatment is insufficient, hospitalization is carried out and the following treatment regimen:

• Antibiotics are prescribed for 7-10 days;
• The stomach is washed, the intestines are cleansed;
• Fresh frozen plasma is used;
• Blood substitutes are introduced to normalize blood functions, salt and electrolyte solutions to obtain a detoxification effect.

For life-threatening complications, surgery is performed.

The operation is performed if the patient:

• Severe intestinal obstruction;
• Prolonged internal bleeding;
• Perforation with peritonitis;
• Intestinal fistula formed.

After the operation, you should undergo an annual examination and routine examination.

Diet

The main part of therapy for diverticulosis is diet.It is necessary to correctly formulate a daily diet, including in the menu:

• Fiber-rich foods, fruits and vegetables;
• Fermented milk products;
• Herbal teas, dried apricots and prunes.

In addition, it is important:

• Exclude flour, smoked, fried foods and semi-finished products;
• Limit the consumption of meat and products with animal fats;
• Eliminate mushrooms and legumes.

Where is intestinal diverticulosis treated in Moscow?

CDB RAS invites patients to consult a proctologist and gastroenterologist in case of suspicion of diverticulosis and other alarming symptoms in the gastrointestinal tract. Appointments for specialists are made by phone +7 (499) 400-47-33.

90,000 Symptoms of diseases of the small and large intestine

The specialists of our clinic effectively and efficiently deal with various diseases of the small and large intestine.At your service are qualified doctors, modern diagnostic equipment, the latest treatment methods. If you are concerned about such pathologies, we are waiting for you in the clinic.

Diseases of the small intestine

In the small intestine, the final process of food digestion takes place, then the absorption of digesting substances, vitamins and minerals. Various diseases of the small intestine manifest themselves in the same way. Most often, our doctor in this case diagnoses “malabsorption syndrome”.

Manifestations of the disease that you may notice in yourself

Diseases of the small intestine, as a rule, are manifested by:

• stool disorders
• rumbling, as well as bloating
• pain.

The most common manifestation is diarrhea 3-6 times a day. Pain occurs in the navel, sometimes in the epigastric region or in the right half of the abdomen. They are most often pulling, aching, bursting and decrease after the discharge of gases. There may be intestinal colic: very severe pain with intestinal spasms.

Small intestine: briefly about diseases

Chronic enteritis – inflammation of the small intestine. The causative agents of acute intestinal diseases play a primary role in its occurrence.Enteritis itself is more often a post-infectious process.
Vascular diseases : abdominal pain after eating, stool disorders. Timely referral to a professional is very important, since a complete blockage of blood vessels can occur.
Allergy , manifested by intestinal disorders.
Gluten Enteropathy : Deficiency of the enzyme peptidase, which breaks down gluten, an ingredient in cereal protein; the disease is manifested by severe diarrhea, weight loss.
A rare disease of Whipple , characterized by severe diarrhea, fever, cramping abdominal pain, weight loss, swollen lymph nodes.
Tumors , mainly benign.

Colon diseases

Colon diseases are:

• ulcerative colitis
• ischemic colitis
• Crohn’s disease
• irritated colon
• dolichosigma, megacolon
• colon diverticulosis
• colon tumors.

Symptoms that you may notice

• Stool disorders
• Abdominal pain
• Abnormal discharge
• Rumbling and bloating.

Stool disorders: constipation is more common. Pain in the anus, sides of the abdomen, above the navel, or in the epigastric region. The pains are cramping or aching, bursting and are not usually associated with food intake. Weaken after bowel movement and flatulence.

Large intestine: briefly about diseases

Ulcerative colitis affects the mucous membrane.Dangerous for the possible development of polyps and tumors.
Irritable colon – a complex of intestinal disorders due to disruption of the intestinal motor function.
Crohn’s disease : the whole intestine, esophagus, stomach is affected.
In ischemic colitis , inflammation occurs due to the narrowing of the vessels that feed the intestinal wall.
Diverticulosis means the presence of multiple diverticula (ending blindly saccular protrusions of limited areas of the intestine) and leads to constipation.
Dolichosigma – lengthening of the sigmoid colon; megacolon – expansion of individual zones or the entire colon. Both diseases cause persistent constipation.
Of benign and malignant neoplasms , the latter are more common. Colon and rectal cancer is now the leading cancer among malignant tumors.

Diagnostics

Difficulties in diagnosing diseases of the small intestine are explained by the peculiarities of its location. The analysis of the clinical picture, histological, endoscopic, immunological methods is of decisive importance.

Almost all diseases of the colon are recognized by fibrocolonoscopy (flexible fibrocolonoscopes with fiber optics are used). The examination also includes:

• study with contrast agents
• angiography
• fistulography
• lymphography
• parietography
• ultrasound
• study with radioactive isotopes.

Treatment of diseases

Our doctors will prescribe effective medicines, vitamins, minerals for you, develop a diet for you.In some cases, surgery is necessary.

You should remember that you should always contact the doctors of the clinic in time, when you can still successfully cure the above diseases. At the appointment with a gastroenterologist, you will be provided with the most qualified assistance, relieving you of discomfort and pain.

what you can do yourself and when to see a doctor

Occasional pain in the lower abdomen is not a cause for concern, but there are dangerous exceptions.

Episodic lower abdominal pain, which is often accompanied by bloating, can be prevented by avoiding certain foods. But if the pain interferes with a normal life, lasts several days, is accompanied by vomiting, fever or blood in the stool, you should consult a doctor.

Main causes of lower abdominal pain

• consumption of foods high in fat;

• stress;

• constipation;

• food intolerances, such as lactose or gluten;

• gastroenteritis, inflammation of the gastrointestinal tract;

• diverticulitis – inflammation or infection of the colon

• intestinal obstruction;

• delayed gastric emptying or gastroparesis in diabetes mellitus;

• inflammatory bowel disease (Crohn’s disease or ulcerative colitis).

Causes that can cause lower abdominal pain and bloating only in women

• menstrual pain;

• endometriosis;

• ovarian cysts;

• inflammatory diseases of the pelvic organs;

• pregnancy;

• ectopic pregnancy.

Similar abdominal problems can be caused by conditions not related to disorders of the gastrointestinal tract or reproductive organs:

• side effects from medications;

• hernia;

• cystitis or urinary tract infections;

• appendicitis or inflammation of the appendix;

• stones in the kidneys.

If lower abdominal pain and bloating are harmless, they should go away within a few hours or days. Contact a doctor if:

• pain increases sharply;

• the temperature rises and holds;

• unusual vaginal discharge appears;

• bloody stools;

• unexplained weight loss occurs;

• severe nausea and vomiting.

The initial physical exam includes pressure on the abdomen to determine where the pain and abnormality are. Urine, blood, or stool tests should be done to look for signs of infection or other causes. Your doctor may order an ultrasound, x-ray, CT or MRI, or colonoscopy to look more closely at your bowel.

How to relieve pain at home

• drink more fluids;

• do flexibility exercises to help escape gas;

• take over-the-counter pain relievers and antacids – drugs to neutralize stomach acid.

The first thing to do to relieve lower abdominal pain is to quit smoking and irritating foods, including:

• too fatty;

• cabbage, lentils and beans;

• dairy for lactose intolerance;

• soda;

• beer;

• chewing gum;

• lollipops.

It’s also good to eat more high-fiber foods like fruits, vegetables, and whole grains to help prevent constipation and bloating.

Earlier, “Kubanskie Novosti” told what blood sugar level is considered normal.

90,000 ᐈ Treatment of diverticulitis in Odessa ➢ Colon diverticula

Contents of the article:

Diverticulum is a saccular protrusion of the wall of the genital organ in the human body.Diverticula are most often found in the digestive tract (esophagus, intestines), less often in the bladder, urethra, etc.

Diagnosis of diverticula is usually random – they are found in the diagnostic search for other diseases using modern methods (CT, MRI, irrigoscopy, fibrocolonoscopy). Often the disease is established after the fact and diverticulitis treatment in Odessa begins already in the presence of complications.

The intestine is a part of the human digestive tract that is responsible for the phased advancement and digestion of food.In humans, two sections of the intestine are distinguished – the thin and the thick. In turn, the small intestine is divided into 3 sections – the duodenum, the jejunum and the ileum. In turn, the large intestine has the following sections: ascending, transverse, descending, sigmoid and rectum. The intestine itself as an organ is a hollow tube containing several layers, the severity of which varies depending on the section of the small and large intestines.

In a simplified form, we distinguish 4 layers in the intestinal tube:

1. mucous – ensures the absorption of substances that enter the intestinal lumen; secretes active biological substances – enzymes that ensure the digestion of food
2. submucosal – provides the strength of the intestinal tube
3. muscular – is the basis for peristalsis – phased undulating movements of the intestine to move food
4. serous – produces a specific secretion that facilitates the sliding of the intestinal loops in the abdominal cavity relative to each other.Also acts as a protective shell for the intestine

The severity of certain layers in the intestine play an important role in the designation of function. So in the small intestine, due to the severity of the mucous and muscular layers, the processes of food digestion prevail. In the colon, on the contrary, the muscle layer is not continuous, but is presented in the form of three ribbons, which in the form of spirals go towards the rectum, which is convenient in the case of evacuation of digestive waste from the body.

Diverticulitis – inflammation of the diverticulum.The causes of diverticulitis are most often blockages of the lumen of the diverticulum with feces, less often with helminths, and gallstones.

Symptoms of diverticulitis vary depending on the type of diverticulum affected.Also, the treatment of diverticulitis in Odessa varies. With inflammation of Meckel’s diverticulum, symptoms appear as in acute appendicitis: pain in the right lower abdomen, fever, general weakness, malaise, nausea, stool disorder. Inflammation of Meckel’s diverticulum is a dangerous surgical disease that requires immediate (urgent) surgical treatment in the form of removal of the latter.

Late admission to the clinic is fraught with life-threatening complications in the form of perforation (rupture) of the diverticulum, followed by peritonitis.Before the operation, the patient undergoes general clinical studies: a general blood test, a general urine test, blood group and Rh factor, ultrasound of the abdominal cavity, kidneys and small pelvis (for women) to clarify the diagnosis.

In the postoperative period, the patient is prescribed antibacterial, anti-inflammatory and analgesic drugs, dressings. The stitches are usually removed 7-12 days after the operation.

In our clinic, we give priority to minimally invasive laparoscopic methods of treatment, which are the “gold standard” in world surgery, reducing the duration of the postoperative period and the required time for rehabilitation after surgery.

Treatment of diverticulitis in Odessa during inflammation of colon diverticula

With inflammation of colon diverticula (acquired), the clinical picture is somewhat different. In this case, you need to start the treatment of diverticulitis in Odessa immediately! The patient is worried about aching constant pain along the large intestine (more often in the left abdomen), which, as a rule, arose after constipation, less often an attack of biliary colic, acute intestinal infection; body temperature rises, stool and gas retention is noted.Such patients require hospitalization in the surgical department for further examination: they undergo a general blood test, a general urinalysis, biochemical blood tests, ultrasound of the abdominal cavity organs, CT scan of the abdominal cavity organs with contrast to determine the level of inflammation, its length, and verification of other complications. Patients are prescribed bed rest, depending on the results of examinations – antibiotic therapy, anti-inflammatory therapy, infusion of crystalloid solutions.If the course is favorable, patients are conducted conservatively with subsequent control blood tests, CT scan of the abdominal organs and further discharge with recommendations and a plan for outpatient follow-up examinations.

In case of an unfavorable course of the disease, patients are operated on. Depending on the intraoperative picture, one- (resection of the affected area with the imposition of a primary anastomosis) or two-stage (primary anastomoses with a discharge colostomy, various modifications of Hartmann’s operation) are performed.In two-stage operations after rehabilitation, patients are subject to planned surgical treatment in the form of colostomy closure.

Our clinic has tremendous experience in the treatment of diverticular disease of the small and large intestines. Our main goal is to provide the highest quality diagnostics for the provision of timely medical care, both conservative and operational.

90,000 Pelvic Pain – Causes, Examination and Treatment | Symptoms

Menstrual cramps
Signs: Sharp or cramping pains that begin a few days before or during menstruation are most intense about 24 hours after the onset of menstruation and subside after 2-3 days, often accompanied by headache, nausea, constipation, diarrhea, or frequent urge to urinating.

Endometriosis
Signs: Sharp or cramping pain that occurs before and during the first days of menstruation, often pain during intercourse and / or bowel movement. Ultimately, it can lead to pain that is not related to the menstrual cycle.

Pain in the middle of the menstrual cycle
Signs: Severe, sharp pain that starts suddenly; can occur on either side, but each time only on one side, occurs at the same time during the menstrual cycle, usually in the middle of the cycle between periods (when the egg is released), is most intense at the beginning, but then decreases within 1–2 days, there is often a slight spotting bleeding.

Inflammatory disease of the pelvic organs
Signs: Aching pelvic pain that can be felt on one or both sides. Typically, vaginal discharge, sometimes foul-smelling, may become pus-like and yellow-green as the infection progresses. Sometimes pain during urination and / or intercourse, fever or chills, nausea or vomiting.

Ovarian cyst rupture
Signs: Pain that starts suddenly is initially limited to one area in the lower abdomen.Sometimes dizziness, fainting, slight vaginal bleeding, nausea, or vomiting occur.

Ectopic pregnancy
Signs: Persistent (non-cramping) pain that begins suddenly is initially limited to one area in the lower abdomen. Often light vaginal bleeding, sometimes dizziness, fainting, heart palpitations, or dangerously low blood pressure (shock) caused by heavy internal bleeding.

Sudden degeneration fibroids in the uterus
Signs: Sudden pain. Most common during the first 12 weeks of pregnancy, after childbirth or termination of pregnancy. Vaginal bleeding may occur.

Torsion (twisting) of the ovarian epididymis
Signs: Severe pain that starts suddenly, on one side, and builds up quickly.And also periodic pain that comes and goes (when the ovary twists and unwinds). Often occurs in pregnant women, after using drugs to treat infertility, or with enlarged ovaries.

Ovarian cancer / Endometrial cancer
Signs: Gradually increasing pain. Brown or bloody vaginal discharge. Abnormal vaginal bleeding (bleeding after menopause or bleeding between periods), sometimes weight loss.

Adhesions
Signs: Pain in the pelvic area, which gradually increases, often becomes chronic. As well as pain during intercourse. No vaginal bleeding or discharge. Sometimes nausea and vomiting (suggesting a blockage in the intestines). In women who have had abdominal surgery or women with a pelvic infection.

Miscarriage
Signs: Cramping pelvic or back pain with vaginal bleeding.Other signs of early pregnancy, such as breast tenderness, nausea, and lack of menstruation.

Appendicitis
Signs: Pain that usually occurs in the lower right side of the abdomen. Loss of appetite and usually nausea and vomiting. Temperature rise often.

Bladder infection
Signs: Pain just above the pubic bone. Sometimes an urgent need to urinate, more frequent urination, or a burning sensation when urinating.

Diverticulitis
Signs: Pain or tenderness in the left lower abdomen, fever.

Inflammatory bowel disease (including Crohn’s disease and ulcerative colitis)
Signs: Cramping abdominal pain, diarrhea, with ulcerative colitis, often with blood in the stool, loss of appetite and weight loss.

Stones in the urinary tract
Signs: Excruciating intermittent pain in the lower abdomen, side or lower back, depending on the location of the stone, nausea and vomiting, blood in the urine.