Edema of the colon
Diagnosis of diverticulum of the large intestine. Symptoms of inflammation of diverticula.
In an acute period of inflammation affected diverticulum is found retrograde on radiographscontrasted colon is very rare, because barium suspension can not penetrate into the cavity of the diverticulum because of the edema of the mucous membrane of its neck. In the area of inflammation in the intestine, thickened and transversely folded folds resembling the palisade (the "front garden" symptom) are seen. The Gausters in this part of the intestine become narrow and take the form of the saw teeth. Sometimes there is a narrowing of the lumen of the intestine due to edema and infiltration of its mucous membrane.
Further under favorable conditions diseases diverticulum scar, deformed,decreases. On radiographs such diverticula have irregular shape, uneven contours, barium suspension for a long time lingers in them. The general appearance of the intestine and the relief of its mucous membrane acquire a normal appearance, in other cases the gut narrowed due to the development of scar tissue, is deformed and fixed by spikes.
With perforation of the wall diverticulum develops local or diffuseperitonitis. X-ray diagnostics of the perforation is based on the detection of free gas in the abdominal cavity or leakage of the contrast suspension outside the intestine. In the case of the formation of the cecal occluded abscess near the affected area of the gut, in a survey study, one can see a gas bubble or small bubbles with liquid levels not moving when the patient's position changes.
Often perforated diverticulum it is difficult to detect, since the developed inflammatory process prevents the entry of contrast suspensions into the diverticulum.
Cill abscess. opening in the adjacent organ (bladder,gut, vagina, etc.), forms an internal fistula. X-ray examination in such cases makes it possible to establish the presence of the fistula and its location. A cinnamon abscess that communicates with the intestinal cavity is detected by the release of the barium suspension from the bowel outline. The form of the abscess can be varied. Barium suspension for a long time lingers in the cavity of the abscess or loose abdominal cavity, sometimes forming a barium granuloma.
Located around the bowel inflammatory infiltrate causes the appearance of a filling fault on theone of the gut contours. The boundaries of the defect are more smooth and even than in a cancerous tumor, the relief of the mucous membrane is preserved, although the folds are often thickened due to inflammatory edema. Inflammation of the intestine by the inflammatory bowel, scarring of the intestine, adhesions can cause obstruction of the large intestine.
Diverticulosis can be complicated by bleeding from an ulceratedthe mucous membrane of the diverticulum. In such cases, the radiologist should first of all exclude cancer or polyp of the large intestine. To determine the source of bleeding can be done with the help of angiography.
Differential Diagnosis of uncomplicated diverticulosis is simple because of its typical radiographicpaintings. Difficulties arise in case of a narrowing of the intestine due to diverticulitis. In addition, diverticula in 2-15% of cases are combined with colon cancer. On irrigograms, the cancerous narrowing has a relatively small extent, the walls of the intestine are rigid, the folds of the mucosa in the narrowed section are destroyed. Inflammation of the colon of inflammatory origin is usually of great length, the rigidity of the intestine is absent, as is the undercutting of the edges of the narrowed section, characteristic of a malignant tumor, the folds of the mucous membrane are preserved.
Spastic bowel contractions. concomitant diverticulosis, disappear after the administration of cholinomimetic agents (atropine, metacin).
Multiple small diverticula can cause serratus of the gut contours,resembling changes in ulcerative colitis. In such a situation it is necessary to take into account the age of the patient, clinical symptoms, the presence of pseudopolyposal changes in the intestinal mucosa, and if necessary, the data of a coloscopy.