notes by dr Claudio Italiano
It is one of the most common diseases in the
gastroenterological field. It is characterized by the presence of "pockets" in
the part of the colon called diverticoli.
We talk about diverticular disease in cases in which in addition to the
anatomical finding of diverticula is associated with painful symptoms or
disorders of the alve.
Double-contrast opaque colon enema, multiple diverticular pockets on the lumen
profile are appreciated in the picture
The writer, by experience, has dealt with several cases, in which erroneously
there was talk of "irritable bowel syndrome" while this diagnosis excludes
organic damage; therefore, care must be taken before diverticulitis, ie the
inflammation of these diverticula, with infection and bleeding.
Fever appears, leukocytosis, signs of inflammation, but the bleeding may not be
there. Bleeding when it is present is always modest, intermittent and can also
be "cloudy", ie without signs of inflammation, and is often referred to the
right colon.
In the right colon, in fact, the diverticula, due to anatomical reasons of the
organ, are larger, with a larger collar and the bleeding is due to arterioles
that run in the submucosa.
The illness begins in stages:
The first stage involves spastic contractions of the colon, similar to the
irritable colon, with thickening of the circular muscle fibers and shortening of
the tapeworms, with sawtooth aspect, without diverticula, in this phase;
The appearance of diverticula is a prerogative of the second stage, but
abdominal pain (abdominal pain) may be missing at this stage.
In the third phase the diverticula are evident, since the "diverticulitis"
appears, that is the inflammation referred to above, due to stagnation of feces
in the diverticular pockets, damage to the mucosa and bleeding, with the risk,
finally, of perforation .
The prevalence in the population, although different in the various studies in
the scientific literature, documents that in the 40-year-olds there is no
pathology but gradually increases up to 30% around the VII decade of life, to
reach 50% in the over-eighty, especially in men, but it seems from recent
studies that women are affected in the same way, also because constipation is
often more a pathology of women.
It generally makes use of a less troublesome examination of the colonoscopy,
which, in any case, is not indicated, if there has been diverticulitis, and even
the radiological examination with double contrast, air and barium, it is: vice
versa, a Once the subject has blazed, so to speak, it is possible to proceed
with the double-contrasted barium enema that will document sacciform outflows of
various shapes and sizes, in each segment of the colon, but especially in the
left-sided colon.
Also the endoscopic aspect is useful for diagnosing; usually, casually, during a
trivial colonoscopy, perhaps performed for other reasons, there are some
diverticular sacs, like more or less depressed oval areas, in the context of the
mucosa.
It must always be entrusted to the specialist gastroenterologist; in general, a
laxative drug is associated, which may be lactulose to an antibiotic such as
rifaximin, with monthly cycles of 7 days;
the diet will be like constipation, with the intent to increase the fecal
volume, but avoiding to administer for example the fruit with all the seeds! For
example, vegetable pasties may preferably be used.
The latest fashion antistipsi of the moment, which I had the opportunity to
admire in a congress, is a drink of kiwi and plum juice, without seeds, becausethe gelatinous juice
is filtred. A very pleasure!
For this purpose, even our Sicilian prickly pears, if properly prepared, ie
filtering the juice from the seeds (called Sicilian jargon "the bones of prickly
pear"!), are good for this purpose.
A total parenteral feeding and the absolute fasting for the risk of perforation in the course of
diverticulitis is indicated. An antibiotic can be used, generally a third generation
cephalosporin or rifaximine by os.
You can have perivisceritis, that is to say inflammation with hemorrhage, the epiploons, as my late surgery professor said, are trying to block the damage, plugging, so to speak, the inflammatory process that could risk to deteriorate in the organ perforation; they result in the strictures of the organ that are taken for suspects, but which in reality are called mycoses.