About diverticular colon disease

Abstract

Relevance. Despite many studies devoted to diverticular colon disease, the results of treatment of this pathology cannot be considered satisfactory. This is primarily due to the fact that the pathogenesis of this pathology has not been fully studied, there are conflicting data on the clinical significance of the level of intraluminal pressure in the intestine and the degree of violation of collagen synthesis in patients. To a certain extent, these criteria can be decisive in assessing the prognosis of the course of the disease in order to timely conduct proactive conservative therapy and adequate surgical aid. The purpose of the study. Improving the results of treatment of patients with complicated course of diverticular colon disease. Materials and methods. There were 194 patients with diverticular colon disease under observation. In 86% of cases, diverticula were localized in the left half of the colon, and isolated sigmoid colon diverticulosis was detected in 68.0% of patients, in the right half — in 4.7% of cases, total diverticulosis — in 9.3% of patients. In patients, the leukocyte intoxication index, the body resistance index, the neutrophil reactive response, the determination of connective tissue dysplasia, connective tissue metabolism indicators, and the measurement of intraluminal pressure in the sigmoid colon were calculated. Results. Conservative therapy was effective in 158 patients (81.4%). Surgical treatment was required for 36 patients (18.6%), with perforation of the diverticulum — in 13.4%, with stenosis — in 5.2% of cases. The nature of the operation was determined by the localization of diverticula and the variant of complication. Postoperative mortality was 2.8%. It was found that connective tissue dysplasia is observed in all patients with diverticular disease, mild — in 36.6% of patients, moderate — in 63.4%. When assessing the intraluminal pressure in 46 patients, its increase was found in all variants of the course of diverticular disease. The average intraluminal pressure was 13.5 ± 0.4 mm Hg. The maximum pressure level was detected in patients with uncomplicated course of the disease. With the development of complications, a decrease in intraluminal pressure was noted. A decrease in intraluminal pressure to 12 mm Hg or less was an unfavourable factor and a predisposition to the development of a complicated course of the disease. The following signs had a significant effect on the recurrence of the disease: age (61-68 years), complications, duration of the disease (more than 4 years), the size of the diverticulum mouth (less than 0.6 cm and more than 1.0 cm), leukocyte intoxication index (more than 2.4 conventional units), the maximum number of rows of the muscle plate of the mucosa and muscle membranes (more than 8.3 and 84 respectively). Conclusions. To predict the course of diverticular disease, a comprehensive analysis of the age of patients, the stage of the disease and its duration, the diameter of the diverticular mouth, the sum of alternative signs of trouble, leukocyte intoxication index, the reactive response of neutrophils, the number of rows of myocytes of the muscle plate of the mucosa and muscle membranes is necessary. Their evidentiary value exceeds 70%. The level of intraluminal pressure in the colon can act as a criterion for the complicated course of diverticular disease.