How are diverticulosis and colon polyps related. What are the main differences between diverticulosis and diverticulitis. Can diverticulosis increase the risk of developing colon polyps. How does the presence of diverticulosis affect colonoscopy screening.

The Connection Between Diverticulosis and Colon Polyps

Recent research has shed light on a potential link between diverticulosis and an increased risk of colon polyps. A study published in the American Journal of Gastroenterology found that patients with diverticulosis had a significantly higher burden of colon polyps compared to those without the condition.

Key findings from the study include:

• 61.9% of patients with diverticulosis had colon polyps, compared to 39.3% of those without diverticulosis
• The mean number of polyps was 1.64 in subjects with diverticulosis, versus 0.93 in those without
• The adenoma detection rate (ADR) was 42.2% in adults with diverticulosis, compared to 22.8% in those without
• Patients with diverticulosis were more than twice as likely to have adenomatous polyps, with an odds ratio of 2.46

These findings suggest a significant positive association between diverticulosis and an increased burden of colon polyposis. While previous reports have been conflicting, this study provides compelling evidence for the relationship between these two conditions.

Understanding Diverticulosis: Causes and Risk Factors

Diverticulosis is a common condition characterized by the formation of small, bulging pouches (diverticula) in the lining of the digestive tract, most commonly in the colon. But what causes this condition to develop?

Several factors contribute to the development of diverticulosis:

1. Age: The risk increases significantly after age 40
2. Low-fiber diet: A diet lacking in fiber can lead to constipation and increased pressure in the colon
3. Obesity: Excess body weight is associated with a higher risk of diverticulosis
4. Lack of exercise: A sedentary lifestyle may contribute to the development of diverticula
5. Genetics: Some people may be predisposed to developing diverticulosis

Is diverticulosis preventable? While some risk factors like age and genetics cannot be modified, adopting a high-fiber diet, maintaining a healthy weight, and engaging in regular physical activity may help reduce the risk of developing diverticulosis.

Diverticulosis vs. Diverticulitis: Critical Distinctions

While diverticulosis and diverticulitis are related conditions, they have distinct characteristics and implications for patient health. Understanding these differences is crucial for proper diagnosis and treatment.

Diverticulosis:

• Presence of diverticula in the colon
• Often asymptomatic
• May cause mild symptoms like bloating or abdominal discomfort
• Managed through dietary changes and lifestyle modifications

Diverticulitis:

• Inflammation or infection of diverticula
• Causes severe abdominal pain, fever, and changes in bowel habits
• Can lead to complications like abscesses or perforations
• Requires medical treatment, possibly including antibiotics or surgery

How often does diverticulosis progress to diverticulitis? Approximately 10-25% of people with diverticulosis will develop diverticulitis at some point in their lives. However, proper management of diverticulosis can help reduce this risk.

The Impact of Diverticulosis on Colonoscopy Screening

The presence of diverticulosis can significantly affect colonoscopy procedures and outcomes. Understanding these implications is essential for both healthcare providers and patients.

Diverticulosis may impact colonoscopy screening in several ways:

• Increased technical difficulty: Navigating a colon with numerous diverticula can be challenging for the endoscopist
• Longer procedure time: The presence of diverticulosis may require more careful examination, extending the duration of the colonoscopy
• Higher risk of missed lesions: Polyps or other abnormalities may be more difficult to detect in a colon with diverticulosis
• Increased risk of complications: There is a slightly higher risk of perforation during colonoscopy in patients with diverticulosis

Are additional precautions necessary for patients with diverticulosis undergoing colonoscopy? While the overall risk remains low, patients with known diverticulosis should inform their healthcare provider before the procedure. In some cases, additional imaging techniques or more frequent screenings may be recommended to ensure thorough examination.

Colon Polyps: Types, Risk Factors, and Clinical Significance

Colon polyps are growths that occur on the inner lining of the colon. While most polyps are benign, some can develop into colorectal cancer over time. Understanding the different types of polyps and their associated risks is crucial for effective prevention and treatment strategies.

Types of Colon Polyps:

1. Adenomatous polyps (adenomas): Most likely to develop into cancer
2. Hyperplastic polyps: Generally not cancerous
3. Inflammatory polyps: Usually associated with inflammatory bowel disease
4. Hamartomatous polyps: Rare, but can be associated with certain genetic syndromes

Risk Factors for Colon Polyps:

• Age (over 50)
• Family history of polyps or colorectal cancer
• Inflammatory bowel disease
• Obesity
• Smoking
• Heavy alcohol consumption
• Lack of physical activity

Why is early detection of colon polyps important? Early detection and removal of polyps can significantly reduce the risk of developing colorectal cancer. Regular screening colonoscopies are recommended for individuals over 50 or those with additional risk factors.

Advanced Diagnostic Techniques for Diverticulosis and Colon Polyps

As our understanding of the relationship between diverticulosis and colon polyps grows, so does the need for advanced diagnostic techniques. These methods aim to improve detection rates and provide more accurate diagnoses, especially in challenging cases.

Emerging Diagnostic Tools:

• High-definition colonoscopy: Provides clearer, more detailed images of the colon lining
• Narrow-band imaging (NBI): Enhances the visibility of blood vessels and surface patterns
• Chromoendoscopy: Uses dyes to highlight subtle changes in the mucosa
• Confocal laser endomicroscopy: Allows for real-time, microscopic examination of the colon tissue
• Artificial intelligence-assisted colonoscopy: Utilizes machine learning algorithms to aid in polyp detection

How do these advanced techniques improve polyp detection in patients with diverticulosis? By providing enhanced visualization and analysis capabilities, these methods can help overcome the challenges posed by diverticulosis, potentially leading to higher adenoma detection rates and more accurate diagnoses.

Treatment Strategies for Diverticulosis and Colon Polyps

Given the potential link between diverticulosis and an increased risk of colon polyps, managing both conditions effectively is crucial. Treatment strategies may vary depending on the severity of diverticulosis and the presence and nature of any polyps.

Management of Diverticulosis:

1. Dietary modifications: Increasing fiber intake and staying well-hydrated
2. Lifestyle changes: Regular exercise and maintaining a healthy weight
3. Medication: Antibiotics or anti-inflammatory drugs if diverticulitis develops
4. Surgery: Reserved for severe or recurrent cases of diverticulitis

Treatment of Colon Polyps:

1. Polypectomy: Removal of polyps during colonoscopy
2. Endoscopic mucosal resection: For larger or flat polyps
3. Surgical resection: For very large polyps or those suspected of harboring cancer
4. Ongoing surveillance: Regular follow-up colonoscopies to monitor for new polyp formation

Can treating diverticulosis help reduce the risk of developing colon polyps? While there’s no direct evidence that treating diverticulosis prevents polyp formation, managing the condition through diet and lifestyle changes may have overall benefits for colon health. Regular screening remains crucial for early detection and prevention of colorectal cancer.

Future Research Directions and Implications for Patient Care

The emerging link between diverticulosis and an increased risk of colon polyps opens up new avenues for research and has important implications for patient care. As our understanding of this relationship grows, it may lead to changes in screening recommendations and treatment approaches.

Potential Areas for Future Research:

• Molecular mechanisms underlying the association between diverticulosis and polyp formation
• Genetic factors that may predispose individuals to both conditions
• Development of targeted screening protocols for patients with diverticulosis
• Evaluation of novel treatment strategies that address both diverticulosis and polyp prevention
• Long-term studies to assess the impact of diverticulosis management on colorectal cancer risk

How might these findings impact current screening guidelines? If further research confirms a strong link between diverticulosis and increased polyp risk, it could lead to more aggressive screening recommendations for patients with diverticulosis. This might include earlier initiation of screening, shorter intervals between colonoscopies, or the use of additional imaging techniques to ensure thorough examination.

The potential relationship between diverticulosis and colon polyps underscores the importance of a comprehensive approach to gastrointestinal health. As research in this area progresses, healthcare providers and patients alike should stay informed about the latest findings and recommendations to ensure optimal prevention and early detection of colorectal cancer.

In conclusion, the association between diverticulosis and an increased burden of colon polyps highlights the need for vigilant screening and management of both conditions. As our understanding of this relationship continues to evolve, it may lead to more personalized and effective strategies for colorectal cancer prevention. Patients with diverticulosis should work closely with their healthcare providers to develop an appropriate screening and management plan tailored to their individual risk factors and medical history.

Diverticulosis Is Associated with Increased Burden of Polypo… : Official journal of the American College of Gastroenterology

Abstracts: SUBMITTED, NOT PRESENTED: COLON

Kung, Jonathan S. MD¹; Mann, Arjun BS²; Shah, Raj MD¹; Singh, Mandeep MD¹

Author Information

1. University of California San Francisco Fresno, Fresno, CA;

2. Fresno State University, Fresno, CA.

American Journal of Gastroenterology 111():p S1227, October 2016. | DOI: 10.1038/ajg.2016.379

• Free

Introduction: Colonic diverticulosis is a common finding in patients with missed colon cancer. It is not clear if this is secondary to technical difficulties in examining the colon in the presence of diverticulosis or rather due to increased incidence of advanced adenomas in these patients. Prior studies have been conflicting regarding the relationship between diverticulosis and adenomas, the precursor lesions for colon cancer. The aim of our study is to determine if colon diverticulosis has been associated with increased adenomas or colon cancer.

Methods: We analyzed data from 585 consecutive colonoscopies in patients undergoing average risk screening for colon cancer defined as those patients with no personal history of colorectal cancer, adenomatous polyps, or inflammatory bowel disease and no family history of colorectal cancer, adenomatous polyps, or hereditary cancer syndromes. Five experienced gastroenterologists performed colonoscopy. Data was collected regarding presence or absence of diverticulosis, number of polyps, location of polyps, pathology of polyps, and size of polyps. Histological analysis was reviewed to confirm adenoma, advanced adenoma, or malignant polyp. Adenoma detection rates (ADR) were also calculated. Chisquare/Fisher’s exact statistical testing were used to analyze results.

Results: Colon diverticulosis was found on colonoscopy in 270 (46.2%) of 585 patients (250 men and 335 women with mean age 54.5 years). Colon polyps were found in 61.9% (167/270) for patients with diverticulosis and 39.3% (124/315) for patients without diverticulosis (p-value <.01). The mean number of polyps were 1.64 polyps in subjects with diverticulosis and 0.93 without diverticulosis (p-value < 0.1). Colon adenomas were found in 31.8% (186/585) patients. ADR was 42.2% (114/270) in adults with diverticulosis and 22.8% (72/315) for those without diverticulosis (p-value <.001). Patients with diverticulosis were more than twice as likely to have adenomatous polyps when compared to those without diverticulosis with an odds ratio of 2. 46.

Conclusion: In our study, colonic diverticulosis was associated with an increased burden of colon polyposis. Previous reports have been conflicting regarding the association between diverticulosis and increased adenomatous polyps, however, in our experience there appears to be a significant positive association in this ongoing study.

© The American College of Gastroenterology 2016. All Rights Reserved.

An unusual diverticulum adjacent to two large colonic polyps; a case report | BMC Gastroenterology

• Case report
• Open Access
• Published: 14 June 2018

• John Schembri 
  ORCID: orcid. org/0000-0001-9900-5239¹,
• Jonathan Bury²,
• Lesley Hunt³ &
• …
• Stuart Riley¹ 

BMC Gastroenterology
volume 18, Article number: 83 (2018)
Cite this article

• 2071 Accesses

• Metrics details

Abstract

Background

Adenocarcinomas can arise in a variety of circumstances in which intestinal segments have been used for urinary diversions. Whereas ureterosigmoidostomy is the oldest and simplest form of continent urinary diversion it also seems to be the most dangerous in this regard. Herein we present a case of colonic neoplasia complicating a non-functioning ureterosigmoidostomy after 55 years; the longest latent period documented to date.

Case presentation

A 56-year-old lady born with congenital bladder exystrophy and who had a functional ileal conduit presented to us with a 6 month history of change in bowel habit and rectal bleeding. Prior to this she had had multiple abdominal surgeries as a child and had suffered from lifelong recurrent urinary tract infections.

Colonoscopy revealed the presence of two large sessile polyps in close proximity to a diverticulum-like structure that after surgical resection turned out to be a non-functioning ureterosigmoidostomy from when she was an infant.

Conclusions

Our case highlights the importance of enrolling patients with ureterosigmoidostomies into long-term colonoscopic surveillance programmes. This is also true for those patients who undergo revisional surgery but have preserved ureteric stumps. Endoscopists should be aware of the varied endoscopic appearances of the anastamosis in order to be able to recognise these structures when present.

Peer Review reports

Background

Ureterosigmoidostomy (US) is the oldest and simplest form of continent urinary diversion. Its association with colonic cancer is well established and a 100-fold increased risk of malignancy has been suggested [1]. Characteristically there is a long latent period before the occurrence of cancer and even though most patients subsequently underwent revisional surgery those with intact ureteric stumps also seem to be at risk [2]. Herein, we report a case of colonic malignancy developing adjacent to a non-functioning US initially mistaken for a diverticulum, 55 years after initial surgery.

Case presentation

A 56-year-old lady presented with a 6 month history of rectal bleeding, passage of mucus and a change in bowel habit to more frequent stools. She had no abdominal pains and her weight was maintained. The patient had been born with bladder exstrophy and had multiple surgeries culminating in a cystectomy with ileal conduit formation at 5 years of age. She had suffered with recurrent urinary tract infections for most of her childhood and adult life but was otherwise well with no other major co-morbidities or risk factors for colorectal malignancy and had no family history of colorectal disease.

Colonoscopy revealed two large sessile polyps in the sigmoid colon in close proximity to each other and adjacent to a diverticulum-like structure (Fig. 1a). Each polyp was approximately 3 cm in size and both exhibited a type IV pit pattern with areas of irregularity suggestive of focally advanced disease. Histological examination confirmed both polyps were adenomas comprising both low and high grade dysplasia, without submucosal invasion (Fig. 1b). On closer inspection the mucosa around the diverticulum was also atypical but not adenomatous. The remainder of the colonoscopy was unremarkable with no other evidence of diverticular disease or polyps elsewhere.

Fig. 1

a Endoscopic view of diverticulum in close proximity to sessile lesion (white arrow; left panel) and close up of raised diverticular structure (right panel). b Magnified view of the H & E-stained histological sections from the sessile lesion showing a typical colonic adenoma with dysplasia. c Magnified view of the H & E-stained histological sections from the diverticulum-like structure showing urothelium adjacent to normal colonic mucosa

Full size image

Endoscopic resection was considered as a therapeutic option however in view of the above characteristics as well as difficult endoscopic access surgery was preferred. Furthermore, radiological imaging had initially raised the possibility of invasive disease in view of sigmoid thickening. The patient underwent high anterior resection and an open approach was chosen because of suspected intra-abdominal adhesions following extensive pelvic surgery. An end colostomy was formed at the patient’s pre-operative request. At laparotomy the right fallopian tube was adherent to the sigmoid colon and adjacent to this a blind ending tube was noted to emerge from the anti-mesenteric border of the colon. This was marked for pathological identification.

Our patient went on to have an uneventful recovery and her quality of life following surgery was good. Her wish to have a permanent colostomy stemmed from the fact that she had always suffered from an erratic bowel habit and that she was already knowledgeable with regards to stoma care in view of her pre-existing ileal conduit.

Discussion and conclusions

The blind ending tube was the remnant of a ureteric implant and the diverticulum-like structure was the site of this US (Fig. 1c). Review of the patient’s records revealed that US had preceded ileal conduit formation when she was still an infant. Although adenomas are often sporadic, the absence of a family history and the development of two large adenomas adjacent to the anastomosis suggests a causal link.

Though initially described in US, all forms of urinary diversion have been associated with an increased risk of intestinal malignancy, typically after a long latent period. In US the incidence of colonic carcinoma is between 2 and 15% with an average age of 33 years and a mean interval from the procedure of 26 years. The shortest and longest reported latencies are 3 and 53 years respectively [3, 4]. Whilst no specific risk factors have been linked to the shorter latency tumours, smoking and tobacco-derived urinary carcinogens might play a role in some cases especially if the diversion has been performed subsequent to bladder cancer resection [5].

Malignancy complicating US is nearly always colorectal in origin, does not seem to arise from urothelium and always develops in close proximity to the anastamotic site. The pathogenesis of these tumours is unclear and multifactorial in nature. The most accepted theory suggests that production of nitrite and N-nitroso compounds from nitrate by bacterial flora in the presence of neutral colonic pH is responsible for carcinogenesis [6]. However, experimental data is conflicting since tumour induction has been achieved in rat models irrespective of nitrosamine formation and whilst it has also been suggested that the interaction of both urine and faeces is necessary for carcinogenesis to occur malignancy can develop in bowel segments only exposed to the urinary stream without faecal interaction [7].

Endoscopically the ureterosigmoidoscopy had the superficial appearance of a diverticulum however these sites may also appear as a small cherry-like structure and caution should be exercised not to inadvertently undertake polypectomy thereby disrupting the anastomosis. With careful inspection and modern-day endoscopic imaging this should be easily avoided. Biopsy sampling would clarify if doubt remained. Endoscopic resection of adenomas close to the anastomosis is feasible but care should be taken to ensure the integrity of the US. Intravenous indigocarmine can be used to identify the ureteric orifices.

Whilst US was the mainstay of urinary diversion up to the 1950s many patients ran into problems with hyperchloraemic acidosis and troublesome diarrhoeas, sometimes with faecal incontinence. A growing awareness of the link with colorectal cancer led to the use of ileal conduits as the preferred option, which do not appear to be susceptable to such change. Revisional surgery was undertaken in many but often, as in this case, the ureterosigmoidoscopy site was left in situ. Unfortunately such patients still appear to have the same increased risk of developing sigmoid tumours exhibiting the same latencies, even in cases where exposure to the urinary stream amounted to 6 months or less [2]. Current guidance suggests that if a ureterosigmoidoscopy is converted to another form of urinary diversion then the site of implantation of the ureters into the sigmoid should be excised [8].

The latent period between US and colonic tumours is characteristically long and even though US is no longer the procedure of choice for infants born with bladder exstrophy it is still considered a viable option to preserve continence. Since most of these patients have had the procedure performed in childhood enough time would have passed for neoplasia to develop before they start undergoing bowel cancer screening, despite the long latency. When encountering this group of patients physicians should ensure they are enrolled in long-term annual surveillance programmes [8]. This would have also been true for our patient, who despite having an alternative form of urinary diversion for most of her life, still had intact US sites that had not been excised at the time of revisional surgery.

Abbreviations

US:

Ureterosigmoidostomy

References

1. Stewart M. Urinary diversion and bowel cancer. Ann R Coll Surg Engl. 1986 Mar;68(2):98–102.

   PubMed 
   PubMed Central 
   CAS 

   Google Scholar 

2. Husmann DA, Spence HM. Current status of tumor of the bowel following ureterosigmoidostomy: a review. J Urol. 1990;144:607–9.

   Article 
   PubMed 
   CAS 

   Google Scholar 

3. “>

   Azimuddin K, Khubchandani IT, Stasik JJ, et al. Neoplasia after ureterosigmoidostomy. Dis Colon rectum. 1999;42:1632–8.

   Article 
   PubMed 
   CAS 

   Google Scholar 

4. Chan CC, Tan A, Salman H. Colon cancer 15 years after ureterosigmoidostomy. J Clin Oncol. 2008 Apr 1;26(10):1755–7.

   Article 
   PubMed 

   Google Scholar 

5. Moyer GC, Grubb RL 3rd, Johnson FE. Intestinal adenocarcinoma arising in urinary conduits. Oncol Rep. 2012 Feb;27(2):371–5.

   PubMed 

   Google Scholar 

6. Kälble T, Tricker AR, Friedl P, Waldherr R, Hoang J, Staehler G, Möhring K. Ureterosigmoidostomy: long-term results, risk of carcinoma and etiological factors for carcinogenesis. J Urol. 1990 Nov;144(5):1110–4.

   Article 
   PubMed 

   Google Scholar 

7. “>

   Kälble T, Tricker AR, Berger M, Amelung F, Waldherr R, Hothorn L, Möhring K, Staehler G. Tumor induction in a rat model for ureterosigmoidostomy without evidence of nitrosamine formation. J Urol. 1991 Sep;146(3):862–6.

   Article 
   PubMed 

   Google Scholar 

8. Cairns SR, Scholefield JH, Steele RJ, Dunlop MG, Thomas HJ, Evans GD, Eaden JA, Rutter MD, Atkin WP, Saunders BP, Lucassen A, Jenkins P, Fairclough PD, Woodhouse CR. British Society of Gastroenterology; Association of Coloproctology for great Britain and Ireland. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut. 2010 May;59(5):666–89.

   Article 
   PubMed 

   Google Scholar 

Download references

Author information

Authors and Affiliations

1. Department of Gastroenterology, Sheffield Teaching Hospitals, Northern General Hospital, Herries Road, Sheffield, S5 7AU, England

   John Schembri & Stuart Riley

2. Department of Radiology, Sheffield Teaching Hospitals, Northern General Hospital, Herries Road, Sheffield, S5 7AU, England

   Jonathan Bury

3. Department of Colorectal Surgery, Sheffield Teaching Hospitals, Northern General Hospital, Herries Road, Sheffield, S5 7AU, England

   Lesley Hunt

Authors

1. John Schembri

   View author publications

   You can also search for this author in
   PubMed Google Scholar

2. Jonathan Bury

   View author publications

   You can also search for this author in
   PubMed Google Scholar

3. Lesley Hunt

   View author publications

   You can also search for this author in
   PubMed Google Scholar

4. Stuart Riley

   View author publications

   You can also search for this author in
   PubMed Google Scholar

Contributions

JS, LH and SR wrote the paper and drafted the manuscript. JB contributed to pathological examination and provision of study material and images. All authors have read and approved the final version of this manuscript.

Corresponding author

Correspondence to
John Schembri.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report.

Competing interests

The authors declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Reprints and Permissions

About this article

Diverticular disease (diverticulosis) of the colon

What is diverticular disease (diverticulosis) of the colon?

Diverticula (lat. diverticulum – literally “branch”, “road to the side”) are sac-like protrusions of all layers of the colon wall or only the mucous membrane and submucosal layer through a defect in the muscular layer.

Figure 1. Cross section of the colon. Diverticulum

Colon diverticulosis is a condition in which there is at least one diverticulum in the colon.

Figure 2. Diverticulosis of the left departments of the colon of

Diverticular disease – a disease characterized by clinical manifestations of the inflammatory process and its possible complications – abscesses, perforation of diverticulums, the formation of fistulas, peritonitis, as well as bleeding.

What is the anatomy of the large intestine?

To better understand the pathogenesis of diverticular disease, consider the anatomy of the colon. The large intestine is a hollow muscular organ – a “tube” located in the abdominal cavity in the shape of a “horseshoe”, and is the final section of the gastrointestinal tract, where the formation and evacuation of feces occurs. It consists of the following sections: appendix, cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum.

The wall of the large intestine consists of four layers: mucous, submucosal, muscular and serous.

Colon mucosa is its inner membrane facing the lumen. It is a thin layer of cells – a cylindrical epithelium. The mucous membrane lies on its own plate, consisting of loose fibrous connective tissue, in which the glands, blood and lymphatic vessels are located. In the deepest layer of the mucous membrane, on the border with the submucosa, there is a muscular plate of the mucous membrane. The epithelium of the mucous membrane performs an integumentary function, is a link between the wall of the large intestine and its lumen – it ensures the absorption of water, the synthesis of B and K vitamins by intestinal bacteria, the formation of fecal masses and their preparation for evacuation, releasing the required amount of mucus.

The submucosa is the layer of the colon wall following the muscularis mucosa. The submucosa contains blood vessels that feed the intestinal wall and nerve plexuses that coordinate its contractions. Due to the submucosa, the mucosa can shift in relation to the next layers of the colon wall and form folds.

Muscle fibers of the intestinal wall are arranged both circularly and longitudinally. This layer acts as a framework, and also ensures the promotion of fecal masses due to contractions.

Outside, the large intestine is covered with a thin “film” – a serous membrane.

For a better understanding of the mechanism of diverticulum formation, one should also pay attention to the peculiarities of the blood supply to the colon wall.

The colon is nourished from the system of superior and inferior mesenteric arteries, originating from the aorta, the main vessel of our body. Their branches form a single marginal vessel that accompanies the large intestine throughout its entire length. Feeding branches depart from the marginal vessel, passing through the muscle layer and branching in the submucosa. With an increase in pressure inside the intestine, sections of the muscular layer through which the feeding vessels pass can serve as a “gateway” for the formation of diverticula.

How does diverticular disease manifest itself?

Uncomplicated diverticulosis is usually asymptomatic – you may not even notice the disease. Diverticula may be an incidental finding during a routine examination. In this situation, no special treatment is required. Recommendations include regular medical supervision, a diet high in fiber and low in refined carbohydrates, and regular physical activity and weight control.

The difficulty of timely detection of diverticular disease lies in the absence of specific symptoms. The clinical picture is presented mainly by cramping pains mainly on the left lower abdomen, increased gas formation, unstable stools with a tendency to constipation or with alternating constipation and diarrhea. Such complaints are mainly associated with dysmotility of the colon.

When they see a doctor, such patients are usually diagnosed with irritable bowel syndrome or dolichosigma, the patient is reassured, an abdominal ultrasound is recommended, and after light therapy, they are sent “home”.

However, in the event of such complaints, a colonoscopy is mandatory! The above symptoms can be manifestations not only of diverticular disease, but also of many other diseases of the colon, the timely detection of which can significantly improve the results of treatment.

Figure 3. Colonoscopy. Orifices of diverticula are visible

The clinical picture of diverticulitis is significantly different. Severe abdominal pain, bloating, lack of stool, may be accompanied by fever, nausea, and vomiting. Such complaints require urgent hospitalization in the coloproctology department, where patients receive antibacterial, anti-inflammatory therapy, and if this treatment is not effective enough, surgical intervention may be necessary.

The main cause of inflammation of a diverticulum – diverticulitis – is the ingestion of dense fecal masses that are unable to come out. At this stage, inflammatory changes and the formation of an infiltrate (seal) of the surrounding tissues occur.

What causes diverticula?

Often at the doctor’s office, patients diagnosed with diverticular disease ask the question: “Why did this disease develop?” What are the causes of this disease? A large amount of information on the Internet does not always give a clear explanation. Let’s try to tell in more detail.

We believe that all the main causes of diverticular disease can be divided into two interrelated groups:

• Increased pressure in the intestinal lumen;
• Weakness of the intestinal wall.

Deficiency of vegetable fiber in the diet leads to a decrease in volume and an increase in the density of feces, which causes disturbances in the motor activity of the large intestine: even to a slight irritation, it reacts with chaotic contractions. Thus, short closed segments of the intestine with increased intraluminal pressure appear, which leads to bulging of the mucosa through the “weak” sections of the intestinal wall – the places where the blood vessels pass.

For a clear understanding of the formation of a diverticulum, we offer you an interesting comparison:

“The wall of the intestine is similar to the layered structure of a soccer ball – strong and hard skin on the outside, and a soft but elastic rubber chamber inside.

Now imagine that a hole, a hole, is formed in the outer hard shell of this ball. What will happen then? The high pressure inside the ball will push part of the soft and elastic inner rubber chamber outward: a pocket protruding outward is formed. This can be compared with a hernia on the abdomen – through a defect in the muscles, the contents “bulge out” outward.

Approximately the same thing happens with the large intestine in diverticulosis. If the pressure inside the intestinal lumen is large, and there are weak spots in the muscular layer, then the inner lining of the intestine tends outward through these holes, forming protrusions in the form of sacs. They are called diverticula.”

What tests should be performed if diverticular disease is suspected?

The first step in the diagnosis of diverticular disease without exacerbation is colonoscopy. With the help of a video camera inserted through the anus, more than a meter of the intestine is examined – the entire large intestine and the final section of the small intestine. Colonoscopy allows not only to see the presence of a diverticulum, but also to determine the size of its gate, the condition of the wall, and the exact localization. If other changes are found in the intestine, colonoscopy allows you to take a piece of tissue for examination – perform a biopsy with further histological examination in order to understand the microscopic structure of the changes. This study can be performed under light anesthesia, which allows you to completely save the patient from the discomfort associated with the procedure.

The “gold standard” for diagnosing diverticular disease is barium enema. This method allows you to determine the number of diverticula, their exact location, size and shape. The essence of the procedure is the introduction of a radiopaque preparation into the colon, after which a series of x-ray images are taken to assess the condition of the colon. In the presented photographs, the arrows indicate the orifices of the colonic diverticula. We marked with blue arrows multiple diverticula of the colon. This is what they look like on a CT scan.

Figure 4. Irrigoscopy. Diverticulosis of the colon

On x-ray images performed during irrigoscopy, multiple diverticula of the colon are clearly visible. They look like sacs filled with radiopaque.

Equally important methods are ultrasound diagnostics and computed tomography. Due to its minimally invasiveness, ease of implementation, ultrasound diagnostics is very relevant at the stage of the initial examination. It allows you to see the presence of diverticula, identify indirect signs of their inflammation, such as infiltration, abscess, or suggest a generalized form – peritonitis.

In order to clarify the data obtained during the ultrasound examination, in case of doubt and to clarify the diagnosis, a spiral computed tomography is performed. Virtual computed tomography allows you to recreate a three-dimensional image of the colon, including the affected areas. Using this technique, you can accurately determine the boundaries of the infiltrate or abscess, other organs involved in the inflammatory process.

Figure 5. Virtual colonoscopy. Orifice of diverticulum

How to treat diverticular disease, diverticulosis and diverticulitis?

Medical treatment

When treated promptly, diverticulitis responds very well to medical treatment. Inflammatory changes are completely cured with the help of antibacterial and anti-inflammatory therapy.

In case of complications of patients, the method of treatment should be selected the most minimally traumatic and minimally invasive. The infiltrate can be completely cured with medication. The abscess can be punctured under ultrasound or CT guidance.

Surgical treatment

In case of peritonitis and the need for surgery in the early stages of the disease, intervention can be performed laparoscopically – through small punctures. Unfortunately, the development of fecal peritonitis usually requires a laparotomy – a “large incision” for thorough washing and examination of the abdominal cavity.

Surgical treatment of diverticular disease without periods of exacerbation is especially important for active travelers, as well as patients living far from district centers. If an exacerbation of the disease occurs away from centers where you can get quality medical care, the consequences can be the most unpleasant. If there are three or more attacks of diverticulitis per year, the patient should contact the coloproctology department to determine the optimal treatment tactics outside the exacerbation period. If surgical treatment is necessary, the operation of choice in this case is the laparoscopic removal of the affected area of ​​the colon and the rectosigmoid junction as one of the causes of increased pressure in the intestinal lumen. Removal of the stoma (even temporarily) in this case is not required.

When is emergency surgery needed?

An urgent operation is necessary if purulent inflammation spreads to the peritoneum, i.e. peritonitis, which is a life-threatening complication.

Is the bowel always exposed to the anterior abdominal wall during an emergency operation?

This issue is decided individually for each patient. Of course, the formation of a stoma is not shown in 100% of cases.

Benefits of minimally invasive surgery for diverticulosis and diverticulitis

The main advantages of minimally invasive surgeries are a satisfactory cosmetic effect (there are no large scars on the anterior abdominal wall) and a faster patient recovery after surgery.

Will the intestine be exposed to the anterior abdominal wall (stoma formation) during a planned operation?

During planned surgical interventions for diverticulosis, the formation of an intestinal stoma is almost never required.

What happens after the operation?

You will be able to celebrate your recovery with your friends by strictly following your diet and doctor’s orders.

Are there ways to prevent recurrence/recurrence of the disease?

First of all, avoid constipation and eating foods with small particles – nuts, seeds, fruits and vegetables with small stones.

How to choose a doctor and medical institution?

Choosing a clinic is a very important issue. Institutions with significant experience in the management of patients with diverticular disease should be selected. Our clinic employs specialists with extensive experience in performing minimally invasive operations.

Dear friends, if you or your loved ones have similar complaints or have already been diagnosed with diverticulosis, do not expect complications, you can always contact our clinic for advice, as well as modern treatment.

Polyps, adenomas, diverticula – where does it all come from in the intestine?

Studio rental for recording

Duration from 50 minutes.

Three guests (experts) can be in the studio at the same time; other experts can be connected online.

The price includes full audio and video support by a broadcast engineer, three cameras, three microphones, three pairs of headphones, studio lighting.

It is possible to install a logo or any screen saver on the monitor screen.

It is also possible to broadcast the broadcast to any service (your website, YouTube, Vkontakte, Odoklassniki, etc.), connect speakers via Zoom, Skype.

[email protected]

Upcoming broadcasts

28
June 16:00

The price of success with Alena Franz

Mysterious disappearance at sea. What….

Alyona Franz

28
June 17:00

Caught in the net

Psychology of the future..

Danae Markovskaya

28
June 18:00

Medicine from A to Z

Let’s talk about causes, symptoms,.