Novosti
Khirurgii

 This journal is
indexed in Scopus
journal cover
android icon Android Applicaion

Year 2014 Vol. 22 No 6

GENERAL AND SPECIAL SURGERY

I.V. HAPONOV

PECULIARITIES OF DIAGNOSIS AND TREATMENT OF COLONIC ACUTE DIVERTICULITIS

SE “Dnepropetrovsk Medical Academy of the Ministry of Health of the Ukraine”
The Ukraine

Objectives. To study peculiarities of diagnosis and treatment outcomes of the colonic acute diverticulitis (AD) using contemporary methods.
Methods. Fifty-eight patients with colonic acute diverticulitis have been observed. Clinical manifestations of the disease, diagnosis and treatment peculiarities have been studied. On the 1st and 4th days after hospitalization content of faecal calprotectin (FC), cytokines (tumor necrosis factor (TNF-α), interleukin-6 (IL-6) and interleukin-10 (IL-10)) have been determined in the blood serum using the method of quantitative immune enzyme test-system for analysis in accordance with the author’s instruction. To control the intoxication, the cell tests of reactivity and intoxication (CTRI) have been determined: leukocytic index according to Kalf-Kalif, Ostrovsky, Fischenko and Khymich, index of leukocyte correlation of Osin, nuclear index of intoxication of Dashtayants. The results of treatment have been analyzed.
Results. During the acute period of the disease the non-invasive methods of diagnosis (US, CT), X-ray and endoscopic methods were considered to be preferable after reduction of acute symptoms. Content of FC, TNF-α, IL-6, IL-10 and ratio TNF-α/IL-10 statistically reliable different from analogue indices of the control group and tended to normalization during the second examination, correlated with CTRI. Conservative treatment was effective in 81% of patients; operative interventions have been used in 11 cases. 5 resections of the sigmoid colon and 4 left-sided hemicolectomies with the application of anastomoses have been carried out; in 2 cases transverse colostomy has been applied after laparotomy.
Conclusion. The diagnosis of acute diverticulitis can usually be made on the basis of the study of clinical symptoms and results of non-invasive (ultrasound, X-ray, biochemical, laboratory) methods of research. At the same time indices of faecal calprotectin, pro- and anti-inflammatory cytokines of the blood significantly vary as well as their ratio, which is thought to be a marker of the disease. In 19% of cases acute diverticulitis requires the operative treatment with preference to carry out resection of the affected parts of colon with the application of anastomoses.

Keywords: colon inflammation, diverticula, clinical trials, treatment
p. 687-692 of the original issue
References
  1. Vorob'ev GI. Osnovy koloproktologii [Fundamentals of Coloproctology]. Rostov n/D, RF: Feniks, 2001. 308 p.
  2. Kondratenko PG, Gubergrits NB,Elin FE, Smirnov LV. Klinicheskaia koloproktologiia [Clinical proctology]: Rukovodstvo dlia vrachei. Xar'kov, Ukraina: Fakt: 2006.385 p.
  3. Bereznits'kii IaS, Zakharash MP, M³shalov VG./ Za red. Kh³rurg³ia [Surgery]. Dn³propetrovs'k, Ukra¿na: RVA Dn³pro-VAL; 2007. 628 p.
  4. Buchanan GN, Kenefick NJ, Cohen CR. Diverticulitis. Best Pract Res Clin Gastroenterol. 2002 Aug;16(4):635–47.
  5. Poida O²., Korolenko VB, Kucher MD, Zavernii LG, Mal'tsev VM, Mendel' AK, Ioffe OIu, Zakharash IuM, Mel'nik VM, Pekhen'ko S². Kh³rurg³ia (Fakul'tets'ka) [Surgery (Faculty)]: p³druchnik dlia VMNZ IV r³vnia / Kiev. Ukra¿na: Meditsina, 2006. 655 p.
  6. Budzak II. K voprosu o differentsial'noi diagnostike vospalitel'nykh i funktsional'nykh zabolevanii kishechnika [Some aspects of differential diagnosis of inflammatory and functional intenstine diseases]. Zhurnal Gastroenterolog³ia. 2013;2(48):81–85.
  7. Stepanov IuM, Fedorov NS. Realii i perspektivy v diagnostike zabolevanii kishechnika [Realities and perspectives in the diagnosis of diseases of the intestine]. Suchasna gastroenterolog³ia. Kiev, Ukraina. 2010;(1):109–14.
  8. Stepanov IuM, Fedorov NS. Soderzhanie fekal'nogo kal'protektina u bol'nykh khronicheskimi vospalitel'nymi zabolevaniiami kishechnika [The content of fecal calprotectin in patients with chronic inflammatory bowel disease]. Suchasna Gastroenterolog³ia. Khar'kov Ukraina. 2010;(2):44–47.
  9. Stepanov Y, Fyodorova N. Evaluation of fecal calprotectin level in patients with chronic inflammatory bowel diseases. J Crohn's and Colitis. 2011;5(5):129.
  10. Manz M, Burri E, Rothen C, Tchanguizi N, Niederberger C, Rossi L, Beglinger C, Lehmann FS.Value of fecal calprotectin in the evaluation of patients with abdominal discomfort: an observational study. BMC Gastroenterol. 2012 Jan 10;(12):5
  11. Mindemark M, Larsson A. Ruling out IBD: estimation of the possible economic effects of pre-endoscopic screening with F-calprotectin. Clin Biochem. 2012 May;45(7-8):552–55.
  12. Thuijls G, Derikx JP, van Wijck K, Zimmermann LJ, Degraeuwe PL, Mulder TL, Van der Zee DC, Brouwers HA, Verhoeven BH, van Heurn LW, Kramer BW, Buurman WA, Heineman E.Non-invasive markers for early diagnosis and determination of the severity of necrotizing enterocolitis. Ann Surg. 2010 Jun;251(6):1174–80.
  13. B³lovol OM, Zaliubovs'ka O². Khron³chnii endotoksikoz ta iogo korekts³ia u khvorikh na erozivnii gastroduoden³t u poºdnann³ z g³pertireozom [Chronic endotoxicosis and its correction in patients with erosive gastroduodenitis combined with hyperthyroidism]. Gastroenterolog³ia. 2013;1(47):24–29.
  14. Mikhailova EI. Aktual'nye voprosy etiologii, patogeneza i diagnostiki vospalitel'nykh i onkologicheskikh zabolevanii kishechnika [Actual problems of aetiology, pathogenesis and diagnosis of inflammatory and oncologic intestinal diseases]: monografiia. Gomel', RB: GGMU; 2009. 184 p.
  15. Mikhailova EI, Filipenko NV. Algoritm differentsial'noi diagnostiki naibolee rasprostranennoi organicheskoi i funktsional'noi patologii kishechnika [Algorithm of differential diagnosis of the most wide spread organic and functional intestinal pathology]. Problemy Zdorov'ia i Ekologii. 2012;(4):76–79.
  16. Hinchey EJ, Schaal PGH, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg.1978;(12):85–109.
Address for correspondence:
49044, Ukraina, g. Dnepropetrovsk,
GU «Dnepropetrovskaia meditsinskaia
akademiia MZ Ukrainy»,
kafedra obshchei khirurgii,
tel.mob.: +38050561-55-87, +380503614427,
e-mail: v_gaponov@ukr.net,
Gaponov Ivan Vladimirovich
Information about the authors:
Haponov I.V. A day-time postgraduate student of the general surgery chair of SE “Dnepropetrovsk Medical Academy of the Ministry of Health of the Ukraine”.
Contacts | ©Vitebsk State Medical University, 2007-2023