home Auditorium 8 Polyps of the sigmoid colon. Polyp of the sigmoid colon: origin, classification, main clinical signs

Polyps of the sigmoid colon. Polyp of the sigmoid colon: origin, classification, main clinical signs

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The gastrointestinal tract may develop various diseases. Often diagnosed and dangerous pathology is the appearance of polyps on the walls of the sigmoid colon. The disease is characterized by the formation of a benign neoplasm. There is a risk of the pathology changing to malignant. Symptoms and treatment of sigmoid colon polyp are interrelated because A complex approach necessarily includes symptomatic therapy.

Polyps on the sigmoid colon are benign formations

In this article you will learn:

General concepts

The sigmoid colon is responsible for the absorption of water and food into the intestinal walls. When exposed to pathological factors and provoking causes, neoplasms may begin to form on the walls of the organ. They are growths on internal walls intestines, which are formed from cells of the mucous membrane. The formation is attached to the surface of the organ by a stalk. The formation of one or more formations is possible.

According to average statistics, the disease is detected in almost 20% of people. More often, tumor formations occur in males, but the predominance is insignificant. The growths can vary in structure, size, type of attachment leg, as well as the number of formations and the ability to malignize.

Villous polyps have a tendency to become malignant.

After diagnosis and establishment of a complete clinical picture, specialists (oncologists and proctologists) determine the method of treatment for the polyp in the sigmoid colon. The scheme is selected individually.

Males are more susceptible to the disease

Reasons for development

The disease progresses due to the activity of its own sigma cells, which, under the influence of provoking factors, have acquired an abnormal character.

The risk of developing polyposis occurs with the progression of pathological processes and diseases:

inflammation of the intestines (chronic form);
violation of the microflora of the gastrointestinal tract;
hereditary predisposition;
stagnation in the stomach due to physical inactivity;
disorders associated with defecation;
unhealthy diet (deficiency of fiber and plant components);

As a rule, the symptoms of polyps in the sigmoid colon have accompanying signs of the underlying pathology.

On video - more information about the symptoms, causes and treatment of intestinal polyps:

Classification

Sigma polyposis is divided into several categories.

Degree of prevalence: single or multiple.
Localization: group or diffusely distributed.
Mounting type: “standing” (narrow leg) or “seated” (wide leg).
Size: small (up to 5 mm) or large (from 1 cm).

The main types of polyps in the sigmoid colon are shown in the table.

View	Peculiarities
Hyperplastic	They are light in color and small in size (up to 5 mm). The form of formation is plaques. Most common.
Adenomatous (glandular)	Size – from 1 to 5 cm. Provoke intestinal obstruction and internal bleeding.
Diffuse	Passed on by inheritance. The size is often no more than 5 mm. They have multiple forms of prevalence. The number of polyps can reach several thousand.

Adenomatous polyp of the sigmoid colon is greatest danger, since a rapidly progressing disease can turn into an oncological form.

Pathology Clinic

During development initial stage pathology, symptoms of a sigmoid colon polyp may be completely absent. In most cases, the disease is detected during the diagnosis of the general condition of the intestine or concomitant disease.

Intestinal polyps may cause problems with bowel movements

The growths do not cause significant discomfort or pain. Pathological formations cause the appearance of symptoms only after an increase in size of more than three centimeters or multiple lesions.

Signs of polyposis:

itching in the anal area (during changes in body position);
pain during sudden movements and during defecation;
blood or mucus clots in feces Oh;
severe bleeding with significant size of formations;
diarrhea/constipation;
false urges to go to the toilet;
nausea and accompanying vomiting, gas formation;
loss of large polyps from the anal sphincter;
weakness, obstruction or fever.

Treatment of sigmoid colon polyp involves targeted symptomatic therapy, which does not require preliminary diagnosis.

Itching in the anus is one of the symptoms of polyp formation

Diagnostic methods

Specialists suspect polyposis as a result of interviewing and examining the patient. Patients are treated by a proctologist or gastroenterologist. At the appointment, a specialist needs to find out the characteristics of the symptoms.

Diagnostics is carried out using the following methods.

Sigmoidoscopy. The examination is performed using an endoscope, which is inserted into the anus. The length of the tube (60 cm) allows you to thoroughly examine the entire intestine and detect even small tumors.
Irrigoscopy. Carrying out an X-ray examination using contrast agent(barium salts).
Colonoscopy. The most informative method of examination, during which a single small polyp can be removed.

Sigmoidoscopy is one of the effective methods examinations

During colonoscopy, the endoscopic characteristics of polypoid cancer of the sigmoid colon are determined by performing a biopsy and examining the resulting material for malignancy.

As additional measures diagnostics are prescribed laboratory research, including analysis of stool for the presence of hidden blood elements.

Complications and prognosis

For sigma polyposis, the prognosis for treatment depends on the characteristics of the neoplasm and the stage of the disease at which it was diagnosed. At early detection and a single form of (non-cancerous) disease – the prognosis is positive.

The absence of symptoms of the disease leads to untimely treatment and, as a result, to complications:

oncology;
abundant internal bleeding(if the formation is damaged);
intestinal obstruction;
inflammation of organ tissues;
intestinal perforation.

The greatest risk to the patient’s life is posed by adenomatous sigma polyp, which increases the likelihood of a cancerous form of pathology.

Intestinal obstruction is one of the possible complications

Treatment options

The disease requires surgical intervention, and no therapeutic method it will not be possible to cure the pathology. Surgery to remove tumors is performed in several ways:

transanal resection;
endoscopic excision;
radical or partial resection.

The method of surgical intervention is determined by the surgeon only after determining all the information about the clinical picture.

Removal of polyps may be prescribed as treatment

Colonoscopy

During a colonoscopy, if polyp growths are detected, a special electrode loop is placed on the stalk of the neoplasm, charring the attachment pathological formation to the intestinal wall. The procedure can be carried out in several stages. The attachment point is additionally charred by high-frequency current.

Transanal resection

The operation is performed under local anesthesia. Using a special tool, the anal passage is widened, through which all growths are removed with a scalpel. The resulting lumen in the intestine is sutured.

Endoscopic excision

The method of surgical intervention is used for the growth of formations of any type, but only when the tumors are located no further than 20 cm from the anus. After removing the growths, the resulting intestinal lumen is sutured.

there are several types surgical intervention for polyps

Resection (complete/partial)

When using resection, partial or complete removal intestine, which is affected by polyps. The operation is performed under general anesthesia using the broadband method. Partial resection is recommended for multiple tumors, complete resection for oncology.

Sigmoid colon polyp is a benign or malignant proliferative process in the glandular epithelium, characterized by the growth into the lumen of the intestine of a mushroom-shaped tumor on a wide or narrow stalk, through which it is connected to the rest of the mucous membrane.

Etiology and classification

The exact reasons for the development of polyps are unknown. Most experts insist that the development of the disease is influenced by a large number of factors:

chronic diseases of the large intestine: chronic colitis, nonspecific ulcerative colitis, Crohn's disease, diverticulosis, etc.;

physical inactivity;

diet violation: low intake of fiber, which reduces intestinal motility, thereby increasing the residence time of bile acids and their derivatives in the intestinal lumen, which have a carcinogenic effect on the mucous membrane of the sigmoid colon;

dysbacteriosis and disruption of microbial passage due to various reasons;

gender: it has been statistically established that men suffer from this disease approximately 3 times more often than women;

heredity: based on the results of the study, it can be stated that 30-35% of patients with a diagnosed polyp had cases of a similar pathology in the family.

Typically, colonic polyps are divided into three types:

To determine the prognosis for possible malignancy (degeneration into a malignant form of sigmoid colon cancer) of a polyp, and, accordingly, the prognosis of the course of the disease, the so-called classification is used depending on multiplicity factors. The smaller the number of polyps, the more favorable the prognosis regarding the incidence of malignancy.

Single (1-5% malignancy). With adequate and timely treatment, the prognosis is favorable.
Multiple (20-25% malignancy). The prognosis is relatively favorable if the diagnosis is made in a timely manner and treatment is started.
- group: 2 or more polyps are detected in the sigmoid colon, there are no polyps in other parts of the colon;
- scattered: in addition to identifying several polyps in the sigmoid colon, polyps are also diagnosed in other parts of the colon (ascending, descending, transverse colons, rectum).
Diffuse polyposis is characterized by a high level of heredity factor in the development of the disease. The course is extremely severe (90-100% malignancy). The prognosis is unfavorable, and even with timely diagnosis, treatment is ineffective.

Clinic and diagnostics

The clinical picture of a sigmoid colon polyp is in most cases quite sparse and occurs with virtually no symptoms. Often, a neoplasm is discovered by chance during irrigoscopy or colonoscopy for some other disease. The first clinical manifestation may appear when the tumor reaches quite large sizes(3 cm or more) and is characterized by symptoms such as pain in the lower abdomen, especially intensifying during defecation, bloody and/or mucous discharge from the anus, various symptoms intestinal dyspepsia (diarrhea, constipation, false urges). In the future, with a long course of the process, symptoms of chronic intestinal obstruction may appear, up to acute intestinal obstruction (most often in late stages tumor development).

If a patient is suspected of having a polyp of the sigmoid colon, it is first necessary to conduct a sigmoidoscopy examination, as well as colonoscopy or irrigoscopy. The first method is quite simple and informative, as it makes it possible to examine the rectum and distal part of the sigmoid colon for the presence of polyps, and if detected, take a piece of tissue for a biopsy, which allows you to determine the degree of malignancy. A thorough examination of other parts of the intestine is required for scattered or diffuse polyposis. For these purposes, irrigation or colonoscopy is performed.

Irrigoscopy is an X-ray contrast method for examining the colon, performed by retrograde injection of a contrast agent. Allows you to detect polyps with a diameter of more than 1 cm. Small polyps are poorly distinguishable, which is a disadvantage of this technique, as a result of which it is now practically replaced by colonoscopy.

Colonoscopy - endoscopic method studies of the mucous membrane and lumen of the colon. Allows you to detect polyps of almost any size, which is an advantage of this method over irrigoscopy. It is also possible to take a biopsy from a suspicious area of the mucous membrane.

Treatment of the disease

Surgical treatment is the main method in diagnosing this disease. Currently for radical removal neoplasms use several techniques:

Sigmoidoscopy or colonoscopic polypectomy with electrocoagulation of the bed.
Microsurgical retrograde tumor excision.
Transanal tumor excision.
Resection of the sigmoid colon with tumor.
Radical removal of the sigmoid colon and regional lymph nodes with the formation of a colostomy.

The choice of a particular treatment method depends on the stage of tumor development, its anatomical location, the general condition of the patient, as well as available medical equipment.

After surgical intervention, the removed material is sent for histological examination, on the basis of which the question of the presence or absence of malignancy in the lesion is finally decided. If there are none, the patient is discharged from the hospital with recommendations for dispensary observation with periodic (once a year) colonoscopy to check for relapse of the disease. If malignant cells are found during the study, then the issue of a more radical method of surgical intervention is decided in order to prevent the spread and progression of the process.

Prognosis and clinical observation

Based on the fact that even colon neoplasms are prone to recurrence, during the first 2 years after surgery, constant dispensary observation with periodic examinations (every 3 months) and colonoscopy (once a year).
According to statistics, relapse of the disease in the first few years is observed in 15% of patients, and half of them experience the appearance of polyps in other parts of the intestine. Identification of a new polyp is an indication for urgent re-operation, since in this case the risk of malignancy of the process with the development of sigmoid colon cancer increases.

When initially removing an already malignant area, more careful monitoring is required: an examination once a month and a colonoscopy once every six months. After 2 years, if there are no symptoms of relapse of the disease, an examination is required once every six months and a colonoscopy once every 2 years. Such patients are subject to lifelong dispensary registration.

There is currently no specific prevention of polyps. To reduce the risk of their occurrence, it is recommended balanced diet, active image life, timely detection and treatment of diseases of the digestive tract.

Luminal polyposis of the colon is a tumor consisting of cells of the glandular epithelial layer. In the majority clinical cases polyps are benign in nature, however, the tendency towards malignancy increases significantly when an adenomatous polyp occurs. Overgrowth is considered by many clinicians to be precancerous condition, developing against the background of multiple exogenous and endogenous factors. Usually the onset of the disease is not accompanied by any symptoms. Timely diagnosis More often it happens by chance when other parts of the gastrointestinal tract are examined for other diseases.

Adenomatous polyp of the colon, what is it - the nature and characteristics of the pathology

Familial adenomatous polyp (otherwise, adenoma, adenomatosis) refers to the precancerous stage of the pathological transformation of the growth. At the core malignant degeneration cells lies change glandular epithelium at the genetic level.

Unlike other types of polyposis, when the neoplasm is a consequence of hypertrophy of the mucous walls of the intestine (multiple factors), adenomatosis has an autosomal dominant type of inheritance and is formed already in the first 2-3 years of a child’s life. Ultrasound reveals both single and multiple adenomas.

Adenomatous polyps are classified into several main forms:

Tubular. Pre-malignant formations are smooth, dense, with smooth edges, and have a light pink tint. As they develop, tubular polyps acquire a lobular structure, a red tint, and increase in size.
Villous. The surface of precancerous growths is lined with multiple branch-like processes resembling villi. Villous polyps are penetrated on all sides by a huge number of blood vessels, which contributes to nutrition and rapid growth. The tissue of the growth is very quickly injured, bleeds, and is susceptible to infection and ulceration. IN clinical practice Villous tumors account for almost 10% of all intestinal diseases.
Villous-tubular. The structure of the polyp includes both villous and tubular elements; they have a rough surface and smooth edges. The neoplasms are quite dense, have enormous sizes, and often lead to serious complications already on early stage of its appearance. The color of the epithelium lining the surface of the polyp matches the shade of the intestinal walls. Only 4-5% of mixed polyps become malignant and metastasize.

Familial adenomatous intestinal polyposis is a genetically determined pathology. The condition is diagnosed in 2 children per 12,000 births. The formation of the first polyps occurs at the age of 13-17, and the first signs are acutely felt only at the age of 28-30.

In the absence of treatment, malignancy of colorectal tumors more often occurs. ICD-10 code – K 63.5.

Dangers and Consequences

Considering the high oncogenic risks, the main danger of adenomatous polyposis is tumor malignancy, metastasis to neighboring organs and tissue structures.

Other consequences are:

Development iron deficiency anemia(due to chronic bleeding);
Deterioration of general condition (fatigue, decreased performance, drowsiness);
Intestinal obstruction;
Unstable stool;
Chronic intoxication.

Another complication is the formation of desmoids - tumors of vascular and connective tissue structures with fibrous changes. Desmoid fibromas form in the anterior wall of the peritoneum, the retroperitoneal space. The mesenteries of the colon and small intestine, other gastrointestinal organs.

Important! Often desmoids are the cause deaths even at the precancerous stage of adenomatous polyps.

Treatment tactics

Treatment tactics are based on:

General clinical history patient;
Differential diagnostic data;
Patient's age.

The only promising treatment is surgery.

It's important to understand that neither traditional medicine nor conservative methods are able to stop the malignancy of the tumor, eliminate the risks of its metastasis and increase the patient’s life expectancy!

Surgery

The manipulation involves excision of the polyp along with hypertrophied areas of the mucous epithelium within healthy tissue.

An important aspect is the removal of the altered glandular epithelium, which underlies the pathological growth. This is necessary to prevent the formation of new growths.

There are colonoscopy and endoscopy, which are minimally invasive and allow you to do the following:

Excision of adenomatous polyp. Access is through the rectum or oral cavity.
Perform resection of adenomatous polyp using an electrode. Surgical access is also rectal or oral.

Often the task of practical surgery is to remove all parts of the colon where there are polypous fragments. Over time, they inevitably degenerate into malignant tumors.

Note! In severe cases it is performed abdominal surgery through an incision in the intestine, peritoneum, prorectal space, followed by removal of part of the intestine or the entire organ. After removing the entire organ, it is possible to create a reservoir from the small intestine.

If the tumor is large enough, then it is partially removed (several manipulations in one procedure). The removed tissues must be sent for histological examination.

Polyps of small volume can be removed using more gentle methods:

Laser coagulation;
Radio wave exposure;
Electrocoagulative treatment.

Here the manipulation is carried out locally, using a narrowly directed beam, a radio wave of a certain power. The surrounding tissues are not damaged, and the cut occurs in the superficial layers of the epithelium. After excision of the polyp, the vessels are coagulated (literally welded together), which prevents the development of bleeding.

The rehabilitation period depends on the extent of the operation performed. With endoscopic and minimally invasive methods of correction at the early stage of pathological growths, patients, subject to all doctor’s recommendations, return to their normal lives within 14 days. In other cases, a longer recovery is required.

Need for surgery

Considering that the only method adequate therapy is a surgical operation, the need for its implementation is determined by the life and health of the patient.

The average survival rate for cancerous degeneration of tumor cells without maintenance therapy is 5-7 years. After surgery and regular follow-up with specialists, patients maintain their usual life expectancy.

The operation is necessary and solves a number of problems that arise with adenomatous polyposis.

Postoperative therapy

Upon completion of the early postoperative period patients are forced to undergo treatment for several years special restoration body. This is necessary to prevent early relapse or the appearance of polyps in the preserved colon tissue.

The main postoperative measures are:

System drug therapy — neutralization and relief of unpleasant symptoms;
Local preparations: suppositories, ointments to eliminate irritation, prevent hemorrhoids;
Diet— compiled individually, taking into account the characteristics of the body.

Important! IN recovery period Regular visits to a proctologist (at least 2 times a year) and a colonoscopy are required. Such measures make it possible to stop the pathological process at the stage of its inception.

Attention! The use of celandine, golden mustache, viburnum decoction, pumpkin seeds, bee products and other alternative medicines may inhibit activity medications Therefore, you should consult a specialist before starting such treatment.

Adenomatous polyp of the sigmoid colon

The sigmoid colon is a section of the large intestine whose function is to absorb water from the food consumed. Anatomically, this department is presented in the form of a sigma - the letter Greek alphabet, which is where it got its name. The localization of adenomatous polyp can be concentrated in parts of the sigmoid colon.

The tissue of the pathological growth consists of glandular-vascular epithelium, the surface of the polyp is lined with a mucous layer. Polyps can be localized or multiple, pedunculated with a spherical body or flat with a broad base.

Regardless of the structure and type of adenomatous polyp, manipulative surgery is prescribed. As is the case with growths on the walls of the colon, conservative treatment methods and traditional medicine are ineffective.

Main surgical methods are:

Polypectomy — classic method with excision of the growth using an electrode loop;
Transanal section— the polyp is cut off along with the changed tissue using a mirror, a clamp and a scalpel;
Endoscopy- insertion of a rectoscope to remove growths located no higher than 20 cm from the anus;
Resection- carried out in severe case when multiple ulcerated growths are noted.

Severe disease usually involves removal of part or all of the sigmoid colon followed by the formation of a colostomy. The specificity of the surgical intervention is determined by the extent of the pathology, its nature and the peculiarities of the development of the disease.

Hereditary adenomatosis of the colon is a serious disease that requires regular diagnosis. The prognosis for colon adenoma is relatively favorable with timely removal pathological tissue and preventing recurrence of cancer lesions.

A polyp of the sigmoid colon is initially a benign growth of the mucous membranes of the sigmoid colon. With a progressive course, the disease is characterized by pain in the lower abdomen, difficulty defecating, and intestinal bleeding. The condition requires mandatory correction. The prognosis varies greatly and depends entirely on the size of the growth, structural and morphological changes, and the age of the patient.

Polyp of the sigmoid colon - proliferation of mucous epithelium in the sigmoid segment intestinal tract. Behind last years the disease is becoming increasingly common among the population, reaching almost 25% of all polyposis formations.

Polyps are differentiated by:

form,
sizes,
structural fullness,
tendencies towards growth and malignancy.

Mucous neoplasms have a stalk or a wide base and can spread over the entire lining surface of the mucous membranes of an organ or be a localized growth.

The danger of the disease lies precisely in the complexity early diagnosis. Unfortunately, most cases are diagnosed at the stage symptomatic manifestations, malignancy of cells into a malignant tumor. Polyp of the sigmoid colon ICD 10 code - D12.5

Lack of treatment almost always leads to serious surgical complications. Depending on the shape and type of wall growth, the prognosis for intestinal cancer is formed.

Predisposing factors

Treatment

There is only one adequate way to treat sigmoid colon polyps - surgical removal. Drug therapy rarely brings positive results, usually used simultaneously with surgical intervention and at the stage of postoperative recovery.

Drug therapy

Drug therapy may be prescribed if surgery is not possible. various reasons, for small polyps without a tendency to malignancy of neoplasm cells. Usually, manipulations with the administration of drugs through a sigmoidoscope are prescribed. Difference between rectosigmoidoscopy and colonoscopy.

Douching, enemas and systemic use antitumor drugs will not bring the desired effect due to the location of the sigmoid colon and its distance from the anus.

There are no traditional methods of treatment. Any recipes that prove high therapeutic results are not clinically proven.

Removal of sigmoid colon polyp

The choice of removal method depends entirely on the course of the disease. Surgeons often combine several methods of intervention to enhance the therapeutic effect.

Popular removal methods are:

After surgery, it is important for patients to follow all medical recommendations and avoid physical activity, ensure sexual rest, protective regime. It is important to follow a therapeutic diet.

The usual diet after removal of polypous growths in sigma requires mandatory correction. The purpose of the diet is to spare the organs digestive system, a significant reduction in the load on lower sections Gastrointestinal tract. Therapeutic effect is aimed at preventing constipation, irritation of the intestinal walls, and reducing the traumatic factor.

The basic rules of the diet after removal of a polyp of the sigmoid colon are::

Fractional meals in frequent small portions (up to 200 ml);
Drink plenty of fluids, 30-40 minutes after each meal;
Reducing the daily amount of salt;
Elimination of fatty, fried foods;
Compliance temperature regime— all dishes should be warm and comfortable for the oral mucosa.

Ideal products during the recovery period would be:

weakly rich broths with vegetables and poultry;
crackers, biscuits;
boiled vegetables (for example, vinaigrette salad);
thick jelly;
porridge with milk;
dairy products.

For drinks, it is better to choose a decoction of rose hips, dried fruit compotes, green tea, decoction based medicinal herbs. During the late recovery period, you can gradually return to your usual diet.

If the removal was carried out due to malignant tumor, That therapeutic diet may be lifelong.

Sigma polyp removal process:

Polyps of the sigmoid colon carry potential risks to human health and life. Timely diagnosis and preventive medical examination reduce the risks of malignant tumor degeneration and improve the quality of life of patients for many years.

Polyps in the intestines are quite common in all age groups, affecting a fifth of the population of all countries and continents. They are found more often in men. A polyp is a benign glandular formation in the intestinal wall, growing from its mucous membrane.

Polyps can occur in any part of the intestine, but are most often affected left half colon, sigmoid and rectum. These benign neoplasms are often asymptomatic, but there is always a risk of their malignant degeneration, so it is unacceptable to let the disease take its course.

It's no secret that all processes in the body depend on what we eat. The nature of nutrition determines not only the characteristics of metabolism, but also, first of all, the state of the digestive system. The intestinal wall, in direct contact with the food eaten, experiences the whole range of adverse effects associated with the quality and composition of the food consumed. Enthusiasm modern man fast food, fatty and refined foods, neglect of vegetables and fiber create digestive problems, contribute to constipation and structural changes in the intestinal mucosa. Under such conditions, excessive proliferation of epithelial cells of the intestinal wall leads to the appearance of not only polyps, but also malignant neoplasms.

A clear definition of a polyp has not been formulated. Usually it means an elevation above the surface of the mucosa in the form of a mushroom, papillary growths or clusters, located on a stalk or broad base. The polyp can be single or multiple, affecting different parts of the intestine. Sometimes there are up to a hundred or more such formations, then they talk about colon polyposis.

The asymptomatic course of polyps does not make them safe, and the risk of malignant transformation increases with their long-term existence and growth. Some types of polyps initially pose a threat of appearance cancerous tumor, and therefore must be removed in a timely manner. This pathology is treated by surgeons, proctologists, and endoscopists.

Since polyps and polyposis are usually diagnosed within the large intestine, this localization of the disease will be discussed below. IN small intestine polyps are very rare, with the only exception being the duodenum, where hyperplastic polyps can be detected, especially in the presence of an ulcer.

Causes and types of intestinal polyps

The reasons for the formation of intestinal polyps are varied. In most cases there is a complex effect various conditions environment and lifestyle, but due to the asymptomatic course, it is almost impossible to establish the exact cause of the polyp. Moreover, some patients do not come to the attention of specialists at all, so the presence of a polyp and its prevalence can only be judged conditionally.

The most important are:

Hereditary predisposition;
Nutritional nature:
Lifestyle;
Pathology of the digestive system, as well as other organs;
Bad habits.

Hereditary factor It has great importance in familial cases of polyp formation in the intestine. This serious disease how diffuse familial polyposis is found in close relatives and is considered an obligate precancer, that is, intestinal cancer in such patients will occur sooner or later if the entire affected organ is not removed.

Nutritional nature significantly affects the condition of the colon mucosa. This influence can be seen especially clearly in economically developed regions, whose residents can afford to consume a lot of meat, confectionery products, and alcohol. For digestion fatty foods a large amount of bile is required, which turns into carcinogenic substances in the intestines, and the contents themselves, poor in fiber, inhibit motility and are evacuated more slowly, leading to constipation and stagnation of feces.

Physical inactivity, sedentary lifestyle and neglect physical activity cause a decrease in intestinal contractility, lead to obesity, which is often accompanied by constipation and inflammatory processes in the intestinal mucosa.

It is believed that the main factor in polyp formation is chronic inflammation intestinal wall (colitis), as a result of which mucosal cells begin to multiply intensively with the formation of a polyp. Colitis is caused by constipation, improper and irregular nutrition, abuse certain types products and alcohol.

The risk group for polyp formation includes people with chronic inflammatory processes of the large intestine and constipation, “victims” of unhealthy diets and bad habits, as well as individuals whose close relatives have suffered or are suffering from this pathology.

The types of polyps are determined by their histological structure, number and location. Highlight single And multiple polyps (polyposis), group And scattered intestinal formation. Multiple polyps have a greater risk of malignancy than single ones. The larger the polyp, the higher the likelihood of it turning into cancer. Histological structure The polyp determines its course and the likelihood of malignancy, which is a rather important indicator.

Depending on the microscopic features, there are several types of intestinal polyps:

Glandular, making up more than half of all neoplasms.
Glandular-villous.
Villous.
Hyperplastic.

Glandular polyps most often diagnosed. They are round structures up to 2-3 cm in diameter, located on a stalk or wide base, pink or red. For them we apply the term adenomatouspolyp, since in structure they resemble a benign glandular tumor - an adenoma.

histological structure

Villous tumors have the appearance of lobular nodules, which are located singly or “spread” along the surface of the intestinal wall. These neoplasms contain villi and a large number of blood vessels, and ulcerate and bleed easily. If the size exceeds 1 cm, the risk of malignant transformation increases tenfold.

Hyperplasticpolyp - this is a local proliferation of glandular epithelium, which for the time being does not show signs of a tumor structure, but as it grows, this formation can turn into an adenomatous polyp or villous tumor. The size of hyperplastic polyps rarely exceeds half a centimeter, and they often arise against the background of long-term chronic inflammation.

A separate type of polyps are juvenile, more characteristic of childhood and adolescence. Their source is considered to be the remains of embryonic tissue. Juvenile polyp can reach 5 or more centimeters, but the risk of malignancy is minimal. Moreover, these formations are not classified as true tumors, since they lack cell atypia and proliferation of glands of the intestinal mucosa. However, it is recommended to remove them because the possibility of cancer cannot be ruled out.

Signs of intestinal polyps

As noted above, polyps are an asymptomatic phenomenon in most patients. For many years, the patient may not be aware of their presence, so a routine examination is recommended for everyone after 45 years of age, even if there are no complaints or health problems. Manifestations of a polyp, if they appear, are nonspecific and are caused by concomitant inflammation of the intestinal wall, trauma to the neoplasm itself or its ulceration.

Most frequent symptoms polyps are considered:

Bloody discharge from the intestines;
Pain in the abdomen or anal area;
Constipation, diarrhea.

Relatively rarely, polyps are accompanied by intestinal obstruction, electrolyte imbalance, and even anemia. Electrolyte metabolism may be disrupted due to the release of a large volume of mucus, which is especially typical for large villous formations. Polyps of the colon, cecum and sigmoid colon can reach large sizes, protruding into the intestinal lumen and causing intestinal obstruction. The patient's condition will progressively worsen, and intense pain in the abdomen, vomiting, dry mouth, signs of intoxication.

Tumors of the rectum tend to manifest as pain in the anal canal, itching, discharge, feeling foreign body in the intestinal lumen. Constipation or diarrhea may occur. Release of blood into large quantities– an alarming symptom that requires an immediate trip to the doctor.

colonoscopy

Diagnostic measures for intestinal polyps often become medical procedure, if it is technically possible to remove the formation using an endoscope.

Typically, to establish a diagnosis, the following is carried out:

Digital examination of the rectum;
Sigmoidoscopy or colonoscopy;
Irrigoscopy with the introduction of contrast (barium suspension);
Biopsy and histological examination (after removal of the formation).

Treatment of intestinal polyps

Treatment of intestinal polyps is only surgical. None conservative therapy or promising traditional medicine is not able to get rid of these formations or reduce them. Moreover, delaying surgery leads to a further increase in polyps, which threaten to turn into a malignant tumor. Drug treatment only permissible as a preparatory stage To surgical intervention and for removal negative symptoms neoplasms.

After removal of the polyp, it must be subjected to histological examination for the presence of atypical cells and signs of malignancy. Preoperative examination of polyp fragments is impractical, since an accurate conclusion requires the entire volume of the formation with the stalk or base with which it is attached to the intestinal wall. If, after complete excision of the polyp and examination under a microscope, signs of a malignant tumor are revealed, the patient may require additional intervention in the form of resection of a section of intestine.

Successful treatment is only possible through surgical removal of the tumor. The choice of access and method of intervention depends on the location of the formation in a particular part of the intestine, size and growth characteristics in relation to the intestinal wall. Currently used:

Endoscopic polypectomy using a colonoscope or rectoscope;
Excision through the rectum (transanal);
Removal through an incision in the intestinal wall (colotomy);
Resection of a section of intestine with a tumor and formation of an anastomosis between the ends of the intestine.

Before surgery to remove a polyp, the patient must undergo appropriate preparation. On the eve of the intervention and two hours before it, a cleansing enema is performed to remove intestinal contents, the patient is limited in diet. When performing endoscopic removal of a polyp, the patient is placed in the knee-elbow position, local anesthetics may be administered or even immersion in medicated sleep, depending on the specific clinical situation. The procedure is carried out in outpatient setting. If intestinal resection and more extensive intervention are necessary, hospitalization is indicated, and the operation is performed under general anesthesia.

Endoscopic polypectomy using a colonoscope

The most common way to remove a colon polyp is endoscopic resection of the formation. It is performed for small polyps and the absence obvious signs malignant growth. A rectum or colonoscope with a loop is inserted through the rectum, which captures the polyp, and the electric current flowing through it cauterizes the base or stalk of the formation, simultaneously achieving hemostasis. This procedure is indicated for polyps of the middle sections of the large intestine and rectum, when the formation is located quite high.

If the polyp is large and cannot be removed at once using a loop, then it is removed in parts. In this case, extreme caution is required on the part of the surgeon, since there is a risk of explosion of the gas accumulating in the intestines. Removal of large tumors requires a highly qualified specialist, the skill and accuracy of whose actions determine the result and possibility dangerous complications(intestinal perforation, bleeding).

For polyps in the rectum located at a distance of no more than 10 cm from anal opening, transanal polypectomy is indicated. In this case, the surgeon, after local anesthesia with a solution of novocaine, stretches the rectum using a special mirror, grabs the polyp with a clamp, cuts it off, and sutures the mucosal defect. Polyps with a wide base are removed within healthy tissue using a scalpel.

For polyps of the sigmoid colon, villous tumors, large adenomatous polyps with a thick stalk or wide base, opening the intestinal lumen may be required. The patient undergoes general anesthesia, during which the surgeon cuts the anterior abdominal wall, selects a section of the intestine, makes an incision in it, finds, examines the neoplasm and removes it with a scalpel. The incisions are then closed with sutures and the abdominal wall is sutured.

Colotomy: removal through an incision in the intestinal wall

Resection, or removal of a section of intestine, is performed upon receipt of the result histological examination indicating the presence of malignant cells in the polyp or the growth of adenocarcinoma. In addition, such a serious disease as diffuse familial polyposis, when there are many polyps and sooner or later they become cancer, always requires total removal of the colon with anastomoses between the remaining sections of the intestine. These operations are traumatic and carry the risk of dangerous complications.

Among the possible consequences of polyp removal, the most common are – bleeding, perforation intestines and relapse. Usually in different terms After polypectomy, doctors are faced with bleeding. Early bleeding manifests itself during the first day after the intervention and is caused by insufficiently good coagulation of the tumor stalk containing blood vessel. The appearance of blood in intestinal discharge is a characteristic sign of this phenomenon. When the scab is rejected in the area where the polyp is excised, bleeding may also appear, usually 5-10 days after the intervention. The intensity of bleeding varies - from minor to massive, life-threatening, but in all cases of such complications, repeated endoscopy, search for a bleeding vessel and repeated careful hemostasis (electrocoagulation) are necessary. In case of massive bleeding, laparotomy and removal of a fragment of intestine may be indicated.

Perforation is also a fairly common complication that develops not only during the polypectomy procedure, but also some time after it. Action electric current causes a burn to the mucous membrane, which can be deep enough to rupture the intestinal wall. Since the patient undergoes appropriate preparation before the operation, then abdominal cavity only intestinal gas enters, but, nevertheless, patients are treated as for peritonitis: antibiotics are prescribed, a laparotomy is performed and the damaged section of the intestine is removed, a fistula is placed on the abdominal wall (colostomy) for temporary removal of feces. After 2-4 months, depending on the patient’s condition, the colostomy is closed, an interintestinal anastomosis is formed and the normal passage of contents to the anus is restored.

Although the polyp is usually completely removed, the causes of polyp formation often remain unresolved, which becomes the cause relapse neoplasms. Re-growth of polyps is observed in about a third of patients. If a relapse occurs, the patient is hospitalized, examined, and the question of choosing a method of treating the tumor is raised.

After excision of the polyp, constant monitoring is necessary, especially during the first 2-3 years. The first control colonoscopy examination is indicated one and a half to two months after treatment benign formations, then once every six months and annually if the disease is disease-free. For villous polyps, colonoscopy is performed every three months in the first year, then once a year thereafter.

Removing polyps with signs of malignancy requires great vigilance and attention. The patient undergoes an endoscopic examination of the intestine once a month during the first year after treatment and every three months in the second year. Only 2 years after successful removal of the polyp and in the absence of relapses or cancer, they proceed to examination every six months.

Excision of a polyp is considered to prevent further growth of such formations and intestinal cancer, but patients who have undergone treatment, as well as those at risk, must adhere to certain rules and lifestyle features:

The diet should include fresh vegetables, fruits, cereals, fiber, dairy products, if possible, you should abandon animal fats in favor of fish and seafood; it is necessary to consume a sufficient amount of vitamins and microelements (especially selenium, magnesium, calcium, ascorbic acid);
It is necessary to exclude alcohol and smoking;
An active lifestyle and adequate physical activity, normalization of weight in obesity;
Timely treatment of diseases of the digestive system and prevention of constipation;
Regular visits to the doctor, including preventive examinations, even in the absence of complaints from predisposed persons.

These simple measures are designed to eliminate the possibility of polyps growing in the intestines, as well as the possibility of relapse and cancer in people who have already undergone appropriate treatment. Regular visits to the doctor and control colonoscopy are mandatory for all patients after removal of intestinal tumors, regardless of their number, size and location.

Treatment with folk remedies has no scientific basis and does not benefit patients who refuse tumor removal, desired result. There is a lot of information on the Internet about the use of celandine, chaga, St. John's wort and even horseradish with honey, which can be taken orally or as enemas. It is worth remembering that such self-medication is dangerous not only in terms of wasting time, but also injuring the intestinal mucosa, which leads to bleeding and significantly increases the risk of malignancy of the polyp.

The only correct option is surgical removal of the tumor, and traditional medicine can only be of an auxiliary nature after surgery, but only in consultation with the doctor. If it is difficult to resist traditional recipes, then chamomile or calendula decoctions, including those with vegetable oil, which can have an antiseptic effect and facilitate the process of defecation.