Diverticulosis & Obscure Bleeding Treatment In India
Diverticulosis & Obscure Bleeding
Small intestinal diverticulosis refers to the clinical entity characterized by the presence of multiple saclike mucosal herniations through weak points in the intestinal wall. Small intestinal diverticula are far less common than colonic diverticula. The singular form is diverticulum, and the plural form is diverticula…
Causes
The cause of this condition is not known. It is believed to develop as the result of abnormalities in peristalsis, intestinal dyskinesis, and high segmental intraluminal pressures…
Frequency
United States : -
Duodenal diverticula are approximately 5 times more common than jejunoileal diverticula. The actual incidence of both types of diverticula is not known because these lesions are usually asymptomatic…
Mortality/Morbidity
Small bowel diverticula are generally asymptomatic, with the exception of Meckel diverticulum. Major complications include diverticulitis, GI hemorrhage, intestinal obstruction, acute perforation, and pancreatic and/or biliary disease in duodenal diverticula…
Symptoms
Most patients with small bowel diverticula are asymptomatic. Patients who develop symptoms generally report symptoms that reflect associated complications…
These complications include the following : -
Diverticular pain – Abdominal pain in the absence of other complications (can be the only manifestation of small bowel diverticulosis) Bleeding – Hematochezia, melena, or obscure bleeding that leads to iron deficiency..
Physical : -
Physical findings are also related to the complications mentioned above. These findings include abdominal fullness, localized or vague tenderness, rectal bleeding, and melena.
No set of symptoms or signs is pathognomonic for small bowel diverticulosis. In the absence of complications, history and physical examination findings are often negative…
Causes
The following risk factors apply to acquired pseudodiverticula : -
Low-fiber diet High-fat diet Advancing age..
Diagnosis
Laboratory Studies
Laboratory tests have limited value in diagnosing small bowel diverticulosis. The following tests may be indicated. CBC count: Elevated white blood cell (WBC) count may occur in diverticulitis. Hematocrit may drop following significant acute or chronic blood loss…
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Imaging Studies : -
Plain abdominal radiograph and/or chest radiograph demonstrates evidence of perforation, including air under the diaphragm; free peritoneal air; evidence of intestinal obstruction; or evidence of ileus, including multiple air-fluid levels and bowel dilatation…
Other Tests : -
Bleeding scan: This is used to determine the site of bleeding if the patient is hemodynamically stable. It is helpful in localizing bleeding sites, detecting bleeding as slow as 0.5 cc/min…
Treatment
Medical Care : –
The general recommendation favors a conservative approach to the management of asymptomatic diverticula. They are generally left alone unless they can be related to diseases….
Surgical Care : -
Complications of small bowel diverticulosis, such as massive bleeding or diverticulitis with perforation, require surgery. Diagnosis is seldom made preoperatively. The aim is to control complications when present and/or to prevent future complications…
Consultations : -
Consultation with a general surgeon is indicated for all patients requiring surgical management….
Diet : –
The role of diet is not clear. A high-fiber diet that improves bowel motility and is used in colonic diverticulosis may be beneficial….
Activity : –
No restriction of activity is indicated…
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