Diverticular disease is a very common disease. The disease is characterized by the formation of diverticula in almost all parts of the gastrointestinal tract, as well as in the urinary and gall bladders.
CAUSES OF DISEASE AND DEVELOPMENT MECHANISM
It is a diverticulum sacciform protrusion in the wall of a hollow organ. According to the histological structure of the diverticula are divided into:
- true, formed by protrusion of all layers of the intestinal wall
- false – represent a protrusion of the mucous membrane and submucosal layer, covered with a serous membrane.
This division is conditional, as the muscular elements of a true diverticulum atrophy with time.
According to some reports, diverticular disease is a consequence of congenital anomalies of the structure of the connective tissue. Intestinal diverticula are also associated with age-related changes in the structure of connective tissue.
The following factors contribute to diverticular disease:
- increase in intestinal pressure,
- sedentary lifestyle,
- systematic use of laxatives,
According to the mechanism of occurrence of diverticula of the small intestine secrete:
- pulsations – occur in dyskinesia and bowel spasms, when relaxation areas appear in the adjacent spasmodic areas, which leads to the protrusion of the intestinal wall.
- traction – in which the intestinal wall is displaced by adhesion, resulting in a diverticulum.
Also, diverticula can be single or multiple. With multiple diverticulums localized in different organs, the congenital nature of their development is most likely.
The causes and mechanisms of development to the end are largely unclear.
TYPES AND SYMPTOMS OF DIVERCULITES
Typically, diverticula of the small intestine are asymptomatic, only occasionally lead to stasis of small intestinal contents. If the diverticulum has a narrow lumen connecting it with the intestine, it is poorly emptied, which leads to the development of the diverticulitis. When diverticulitis occurs, abdominal pain, dyspepsia symptoms (nausea, loose stools), body temperature may rise, intoxication may appear.
There are forms of diverticulitis:
When gangrenous form possible perforation due to necrosis of the intestinal wall. Perforation, inflammation and bleeding are much less common than with colon diverticulosis. In diverticula, fecal stones may form, leading to intestinal obstruction.
A single duodenal diverticulum usually has no clinical manifestations and is detected by chance during X-ray examinations. Sometimes it is localized near the major duodenal papilla and is associated with cholelithiasis, which constitutes a certain risk when performing ERCP.
Diverticulum of the duodenal bulb is rare, found in patients with localization of recurrent ulcers in the duodenal bulb. Patients with a duodenal diverticulum do not need treatment if complications have not developed. Surgical treatment is indicated for perforation, bleeding, and sometimes microbial insemination with the development of duodenitis and duodenostasis.
Almost always, multiple diverticula of the small intestine are located on the mesenteric region and do not have clinical symptoms until inflammation due to microbial contamination (dissemination) of these sections of the intestine does not join.
It differs from other variants of Mecke-cel diverticulum by its origin, is a congenital anomaly caused by incomplete overgrowth of the gastrointestinal or umbilical-intestinal duct. In the postnatal (after birth) period, a diverticular-like formation remains localized in the wall of the small intestine, on the opposite side from the attachment of the mesentery, at a distance of 40–50 cm from the ileocecal valve (bauginovy valve), its length is usually 4–6 cm, the diameter can reach the diameter ileum.
Meckel’s diverticulum occurs in 2% of people, but only 5% of patients have clinical manifestations, among which the main is bleeding, which is caused by the inflammation of the diverticulum, but it is usually small.
The clinical picture of the diverticulitis and the perforation of Meckel’s diverticulum do not differ from acute appendicitis and require surgical treatment. For the diagnosis of a diverticulum, an x-ray examination is used, with barium being injected through a probe for a ligament of Treitz.
Most often, the Mekkel diverticulum is found during surgery.