Authors
Levchuk A.L.1, Abdullaev A.E.2
1 National Medical and Surgical Center named after N.I. Pirogov, Moscow
2 GKB SMP, Vladimir
Abstract
The aim of the study is to evaluate and improve the modern diagnostic capabilities and treatment results of patients with DBTC with the formation of its stricture.
Materials and methods. A study was conducted with the participation of 17 patients treated at the State Clinical Hospital in Vladimir from 2013-2023 with DPC complicated by the presence of benign stricture of the sigmoid colon on the background of DBTC. According to emergency indications, 6 (36%) patients with a clinical picture of acute colonic obstruction were hospitalized. In 11 (64%) cases, strictures of the sigmoid colon against the background of DBTC occurred, detected at the outpatient stage. In differential diagnosis with CRC, the level of cancer markers CA19-9, REA was determined, and histological verification was performed. In 6 (36%) patients, the colonic obstruction had an obstructive character. In 2 (12%) cases, partial colonic obstruction was diagnosed, which resolved after conservative treatment. In 3 (18%) cases of obstructive intestinal obstruction, fibrocolonoscopy was performed after its resolution. Laparoscopic interventions were not performed.
Results: In 7 (42%) cases, against the background of ultrasound signs of colon diverticulosis, a narrowed area in the intestinal wall and signs of colonic obstruction were determined. Fibrocolonoscopy with biopsy was performed in 8 (47%) patients. An increase in the level of CA 19-9, REA has not been registered. In 12 (71%) cases, abdominal MSCT with intravenous contrast was performed. In 4 (24%) patients, there was a CT scan of the stricture of the sigmoid colon with phenomena of colonic obstruction. In 8 (47%) cases, a section of the sigmoid colon with signs of stenosis without intestinal obstruction. Surgical treatment was performed in 100% of cases. Obstructive resection of the sigmoid colon according to Hartmann was performed in 3 (17.6%) patients. In 14 (82.3%) patients, sigmoid colon resection was performed with the imposition of primary colonic anastomosis. LGE with the imposition of primary anastomosis was performed in 4 (23.5%) cases. There were no fatalities. Insolvency was diagnosed in 1 (5.8%) patient after sigmoid colon resection for DBTC. Suppuration of the postoperative wound occurred in 1 (5.8%) patient. 1 (5.8%) patient developed bilateral polysegmental pneumonia in the postoperative period.
Conclusion: Acute colonic obstruction caused by stenosis or stricture of the colon on the background of BTK is a late and relatively rare complication of it. The main method of accurate diagnosis of DBTC with the formation of intestinal stricture is fibrocolonoscopy with biopsy and morphological examination of the stenosis zone, CT of the abdominal cavity with contrast. The only radical method of treatment for this category of patients is surgical intervention. The use of modern diagnostic methods allows you to choose the most optimal amount of surgical aid. Endoscopic stenting is regarded as a “bridge” to planned intestinal resection with the possibility of applying primary colon anastomosis.
Keywords: diverticular colon disease, late complications, stricture of the colon.
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