Colon diverticulosis – causes, symptoms, investigations, treatment
Colic diverticula are hernias of the mucosa and submucosa by circular muscle layer of the colic wall.
As frequency, colic diverticulosis affects approximately 5% of the population. The frequency of this disease increases with age.
It is considered that the following factors have an important role in the production of colic diverticula:
– Colic motility disorders – chronic constipation, spastic colitis, colic stenosis leading to increased pressure in the intestinal lumen;
– “Vascular” factor – most diverticula occur at the points where blood vessels pass through the colic wall, these points are areas of low resistance through which the mucosa will breach;
– Close relationship of the diverticula with blood vessels explains their tendency to hemorrhage (bleeding);
– Diet – low in fiber favors production of colic diverticula, some noted that colic diverticulosis is more common in industrialized countries compared to others.
In terms of pathology, macroscopic, colic diverticula appear as small dilations (from several mm to several cm diameter), round, oval or saccular. Colic diverticula can be single or multiple, are usually between 10 and 30 to a patient. Regarding the location of these diverticula, it was found that the colon is the seat of diverticulosis in 50% of cases, in the sigmoid and descending colon diverticula are located in 80% of cases. Diverticulosis is usually sectoral, rarely generalized.
The clinical picture of uncomplicated diverticulosis differ considerably from that of diverticulitis (inflammation of a diverticulum).
Uncomplicated diverticulosis is often asymptomatic or latent. May present signs of irritable bowel (colicative abdominal pain, accompanied by frequent stools). This pain can persist for long. Sometimes there is a lower gastrointestinal bleeding.
Diverticulitis (inflammation of the diverticula) is clinically characterized by the following symptoms:
– Colicative and persistent abdominal pain located in left iliac fossa or suprapubic;
– Rectal bleeding (red blood emission, non-coagulated through the anus), the most common is microscopic;
– Bowel disorder;
– Fever and chills;
– Tenderness or defense in left iliac fossa .
For diagnosis of certainty, will conduct a series of X-ray imaging with contrast, colonoscopy, CT (computer tomography), MRI (magnetic resonance). A very important investigation is irrigography by double contrast.
Colic diverticulosis can evolve long time asymptomatic or with minimal clinical manifestations. A small number of patients may develop a series of bleeding complications (which can be microscopic or as lower gastrointestinal bleeding), infection (diverticulitis or acute sigmoiditis), occlusive (intestinal occlusion), bladder, vagina, ureter fistulas.
Regarding treatment, uncomplicated diverticulosis requires no special treatment, except for combat constipation (by supplementing the diet with fiber, providing an optimal amount of liquid) or treatment of colitis.
The first attack of diverticulitis should be treated conservatively by adequate nutrition, antibiotics, laxatives.
Surgery is reserved only for cases of complicated diverticulitis.