Diverticulum

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Diverticula can be seen in this image, viewed from the outside, as those smaller vesicular, irregularly distributed protuberances from the inside of the sigmoid colon ( intestinal lumen ) to the outside. The horizontally running meandering band is one of the longitudinal muscle bands (taenium).
A diverticulum of a man's urinary bladder on CT image. It shows a protuberance of the bladder lumen in the direction of the coccyx, see bottom right. The VR display at the top left shows the area described with a circle.
Bladder diverticulum of a 59-year-old man, transverse plane

In medicine, a diverticulum is a vesicle, pear or sac-shaped protuberance on the walls of hollow organs . Diverticula occur prenatally as a normal stage of development of various organs . After birth, diverticula are deviations from the normal state of the body. However , there is usually only a need for treatment if there are complaints. They are created by pushing or pulling.

Diverticulum with possible disease value

Diverticula are most common in the large intestine (called colon diverticula ), but can also occur in all other areas of the digestive tract between the throat and rectum . In the urinary system , the ureters , bladder or urethra can be affected. Diverticula are relatively rare in the heart . Occasionally they appear as tracheal diverticula in the windpipe .

Diverticula can be congenital or acquired and are distinguished according to their shapes:

  • Real diverticulum : In a real diverticulum, all of the wall layers are everted. The cause is usually a pull from the outside (so-called traction diverticulum ). An example is Meckel's diverticulum in the ileum , part of the small intestine.
  • False diverticulum (pseudodiverticulum): Individual wall layers - mostly just the mucous membrane and the layer directly underneath - are everted through gaps in the muscles (for example at vascular penetration points). The cause is usually an increased pressure within the hollow organ, combined with weak walls (so-called pulsation diverticulum ). Examples are the Zenker's diverticulum of the pharynx or the diverticulum of the esophagus that occurs above the diaphragm (“epiphrenic diverticulum”). An epiphrenic diverticulum is often associated with smooth muscle dysfunction or hiatal hernias .
    • Diverticula of the intestine (intestinal diverticulum ) are mainly found in the large intestine (especially in the sigmoid). They arise from a prolapse of the mucous membrane through the muscle gaps in the intestinal wall, so they are mostly pseudodiverticula. These muscle gaps are actually where the intestinal wall vessels pass through and thus represent a predilection for the formation of diverticula. In some cases the diverticulum can initially run intramurally (within the intestinal wall), later the mucous membrane protrudes in size and the diverticula can become symptomatic. This is often the case in older people (> 60 years). The cause of the mucous membrane protuberance is assumed to be increased internal intestinal pressure (= intraluminal pressure), which in turn is supposed to result from an insufficient dietary fiber content in the food. However, a current study could not prove a protective effect through a high fiber content. Rectal diverticula are extremely rare in humans, but are more common in dogs, particularly when associated with a perineal hernia.

In a diverticulosis (diverticular disease) many diverticula are. In principle, these do not cause any complaints. If symptoms develop during diverticulosis, it is referred to as symptomatic uncomplicated diverticular disease (SUD). The underlying chronic inflammation that occurs is localized. Only when diverticulitis it comes to the inflammation of one or more of these diverticula.

Diverticulum in prenatal development

In the normal course of prenatal development, the kidneys , lungs and thymus are initially created as diverticula from previous structures.

See also

Web links

Individual evidence

  1. ↑ See for example Hans Adolf Kühn: Diseases of the stomach and duodenum. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid. 1961, pp. 767-804, here: pp. 808 f.
  2. ^ Anne F. Peery, Patrick R. Barrett, Doyun Park, Albert J. Rogers, Joseph A. Galanko, Christopher F. Martin, Robert S. Sandler: A High-Fiber Diet Does Not Protect Against Asymptomatic Diverticulosis . In: Gastroenterology , February 2012
  3. ^ Peter F. Suter et al .: rectal diverticulum . In: Peter F. Suter, Barbara Kohn (ed.): Internship at the dog clinic . 11th edition. Paul Parey, Stuttgart 2011, ISBN 978-3-8304-1193-2 , pp. 724 .
  4. ↑ Diverticular disease. Retrieved June 29, 2020 .