English
Diverticulum
Introduction
Introduction Digestive tract diverticulosis refers to the local cystic bulging of the digestive tract, both true and false. The former refers to full-thickness bulging, the latter only has mucosa and submucosa without muscle layer bulging, and most of the diverticulum bulges out of the digestive tract, and a few bulges into the cavity, which is called sputum. Multiple diverticulum is also known as diverticulosis. The disease is seen in the whole digestive tract, with the colon being the most common, followed by the duodenum, and the stomach diverticulum is the least common. Diverticulosis with symptoms or complications is called symptomatic diverticulum or diverticulosis and requires treatment.
Cause
Cause
Because the blood vessels in the upper part of the jejunum and the end of the ileum are thick, the muscle layer of the intestinal wall is weak in the thick blood vessels, so the diverticulum is more likely to occur in these parts, especially in the upper part of the ileum. In addition, long-term intake of low-fiber foods, the intestinal pressure continues to rise, the elderly are prone to hair loss associated with intestinal muscle weakness. Although the specific cause of diverticulum formation is not known, most experts believe that the pressure generated by the excretion of small pieces of hard manure from a low-fiber diet is the main reason for its formation. The high pressure generated by abnormal colon movement (possibly due to low fiber content in the diet) forces the intestinal endothelium to penetrate the weak points of the extra-colonal muscle layer.
Examine
an examination
Related inspection
Gastrointestinal CT examination of digestive tract hormones
(1) Abdominal plain film examination: Abdominal plain film examination of simple diverticulosis is usually normal and therefore of little value. Image characteristics of diverticulitis: The cupping network is: the displacement or stenosis of the intestinal wall, and the mucosa changes. In the proximal or distal intestine of the lesion, multiple abdominal diverticulum can be seen in the abdominal cavity. Abdominal abscess can be found, and multiple gas caused by intestinal colon obstruction Liquid level and flatulent intestines.
(2) Enema: the use of tincture or water-soluble contrast agent for contrast enema is more reliable for the diagnosis of asymptomatic diverticulosis than for colonoscopy. The diverticulum filled with diverticulum is characterized by prominent spheroids of the colon wall. Diverticulum imaging can still be seen after discharge, without inflammation, which may mask the diverticulum. Sometimes the room is turned over or accumulated in stool and is easily confused with polyps. Therefore, it should be observed and photographed in multiple directions. After emptying, the film can improve the diagnostic accuracy.
B-ultrasound
Colonic diverticulum is less used, but it has the advantages of no damage, economy, convenience, etc. It is often used for percutaneous puncture drainage of extracolonic abscess. B-ultrasound has a great effect on the identification of inflammatory masses and abscesses. If the small intestine bloating inflammatory mass and abscess are small, the diagnosis of B-ultrasound is of little value.
Diagnosis
Differential diagnosis
The diagnosis of this disease should be differentiated from irritable bowel syndrome, colon cancer, Crohn's disease, and genitourinary diseases. It is worth noting that a small number of patients with diverticulum and irritable bowel syndrome or colon cancer can coexist.
1. Colon cancer Colon cancer has more similarities with diverticulosis: the incidence increases with age; can occur in any colon site, multiple sigmoid colon; clinical symptoms are similar, such as bowel habits change lower abdominal pain; can cause obstruction Or perforation; the clinical course is more concealed. However, diverticulitis is more severe with abdominal pain, accompanied by fever and leukocytosis; colon cancer hemorrhage is occult blood positive or a small amount of bleeding, while diverticulum hemorrhage can be small, moderate or massive bleeding. About 20% of diverticulum patients with polyps or tumors, Boulos et al reported that 23% of diverticulum patients had colonic polyps, 8% of diverticulum patients had malignant colon tumors, and barium enema had a higher false positive rate. Forde reported that 11 of 12 patients were suspected of having a tumor, and a sigmoid colonoscopy excluded the malignant tumor. The false positive rate of diagnosis of barium enema is 10% to 20%. The false positive rate of diagnosis of polyps is 22% to 35%. Therefore, for left colon lesions, sigmoidoscopy is the preferred method of examination. 2. Appendicitis cecal diverticulitis or sigmoid diverticulitis in the right lower abdomen may appear similar to appendicitis symptoms, but appendicitis is more common than diverticulitis, and there are many characteristics of metastatic abdominal pain. The early pain of cecal diverticulitis is fixed in the right axillary fossa, not in the umbilical or upper abdomen. The pain does not start from the umbilical or upper abdomen. It is longer from the onset of symptoms to the admission (3 to 4 days), vomiting is rare, nausea and Diarrhea is more common. If appendicitis is not ruled out, surgical exploration is required. If diverticulitis is found, it is usually removed. Therefore, when the right lower quadrant pain is encountered and the cause is not clear, a CT scan can be performed to rule out diverticulitis. 3. Inflammatory bowel disease Colonic inflammatory disease and diverticulitis can have abdominal pain, changes in bowel habits, blood in the stool and fever. Ulcerative colitis is easy to distinguish from diverticulitis, ulcerative colitis almost all affect the rectum, so rectal microscopy can easily and accurately rule out ulcerative colitis. Both sinusitis, obstruction, and abscess can be formed in both diverticulitis and Crohn's disease. When multiple intraluminal lesions and longitudinal submucosal fistulas are found by angiography, Crohn's disease is more likely. In elderly patients, diverticulosis and Crohn's disease are more difficult to identify when enema or endoscopy is available for proper diagnosis. 4. Gastrointestinal bleeding in the diverticulum and blood, the symptoms are similar to duodenal ulcer bleeding, such as a large amount of bright red blood discharged through the rectum, often accompanied by hypovolemic shock performance, should be carefully identified the medical history, physical examination, indwelling gastric tube, gastroscopy The cupping network can exclude the upper gastrointestinal bleeding health search. Congenital vascular dysplasia Arteriovenous malformation telangiectasia, vascular disease, etc. are the cause of lower gastrointestinal bleeding. Diverticulosis with massive hemorrhage, radionuclide scanning and colonoscopy are helpful for diagnosis, but selective mesenteric angiography is the most reliable and most diagnostic test for acute bleeding, depending on the angiography, distribution, contrast agent spillage and Intestinal tube visualization determines the location of the lesion and distinguishes between diverticulum, tumor and vascular malformations.The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.