Pseudopolyps colon is a disease in which the mucous membrane of the intestine are formed by the protuberances, in appearance resembling polyps. Unlike true polyps which may be single, these formations are always multiple.
In its clinical entity pseudopolyps colon is a secondary disease, as it develops on the background of other diseases of the colon.
Colon is a big part of the large intestine that extends from the blind to the sigmoid colon. Pseudovariety formed on the inner surface of its walls, is most often found in the background of ulcerative colitis – in 22-64% of all patients diagnosed with colitis.
Most often affects patients in the age group of 40 to 65 years, men and women get approximately the same frequency.
Treatment are at the proctologist, but recommended periodic inspection of such patients the oncologist.
Causes of pseudopolyposis colon
Morphologically pseudopodia are plaques of different shape and size, which are formed on the mucosa of the large intestine and protrude above its surface.
The reasons for the development of such plaques can be:
- infectious inflammatory;
Traumatic considered all the causes which led to the violation of the integrity of colonic mucosa, which further gave impetus for growth in this place of the tissues of the mucosa. Injury to the internal surface of the colon arise from:
Cause injury of the mucous membrane of the colon can cause medical manipulations:
To potentially traumatic diagnostic procedures include colonoscopy – the inspection of the inner surface of the colon with the help of introduced in the lumen of colonoscope (species endoscope optical system). The immediate cause can be:
- improper condition of the equipment;
- breaching techniques colonoscopy;
- the lack of physician experience in the application of the colonoscope.
Therapeutic manipulation, during which the possible injury of the mucous membrane of the colon is surgery about one or another of her illness:
- removal of tumors, scars, strictures of the wall of the colon;
- the formation of different anastomosis (artificial messages between different segments of the intestine);
- plastic surgery
and so on.
Such injuries often occur during prolonged extensive operations as if they should arise suspicion as to the form of pseudopolyposis.
Injury of the intestinal mucosa with subsequent development of pseudopolyposis perhaps as a result of persistent constipation on the background of various diseases of the colon. Compacted stool constantly irritate in the same place, provoking its expansion.
Fecal stones are solid structures that are formed from compacted fecal “deposits” and they look like normal stones. Such education often damage the mucous membrane of the colon in a case if the passage through the intestines they turned around and stuck in the lumen. Approaching the stool is pushed up the natural intestinal “tube”, but she still manages to tear the mucous membrane of the colon – in this place in the future and develop pseudopodia.
Foreign bodies get into the gastro-intestinal tract if swallowed:
Unintentionally traumatic things swallow inadvertently. In the second case it occurs at the mentally ill, inadequate people who are trying to harm their own health (by suicide to escape from social responsibilities, in particular, from service in the army or from the legal responsibility). Often swallow knives, forks, studs, pins, badges, pins, nails, keys and so on.
The participation of aggressive chemical substances as a causal factor of pseudopolyposis of the colon occurs less frequently, such liquid being swallowed, reaches the colon in small quantities, because on the road, mingles with intestinal contents, or be absorbed into the wall of the gastrointestinal tract. However, about the chemical damage that may cause development of pseudopolyposis colon, remember.
Isolated inflammation rarely triggers the development of the described disease the lumen of the large intestine is inhabited by a large number of microflora, and therefore inflammatory and infectious component in the mechanism of development of pseudopolyposis inseparable.
Most often, the development of pseudopolyps cause diseases such as:
- ulcerative colitis – an inflammatory lesion of the mucous membrane of the large intestine (including colon), against which the formed ulcer damages the lining;
- Crohn’s disease is the formation of multiple granulomas-tubercles in the mucosa of different sections of the intestine (in this case, in the colon);
- dysentery – an infectious disease of the large intestine (mainly the end of divisions) caused by Shigella.
Trophic shifts (malnutrition) of the mucous membrane of the large intestine, which lead to the formation of pseudopolyps develop for reasons such as:
- the disruption of the microcirculation of the intestinal wall – a failure of blood circulation at the level of small vessels;
- the malabsorption in the gastrointestinal tract, resulting in deteriorating the supply of nutrients to tissues including tissues of the colon.
Impaired microcirculation may occur due to:
- vascular disease – partial blockages, obliteration (overgrowth) of arterioles and venules (arteries and veins of small caliber), and also of the capillaries, their deformations, and other failures, which disrupted the flow of blood in the microcirculatory system;
- violations by the blood – in particular, enhancing blood clotting with subsequent formation of small blood clots.
The malabsorption in the gastrointestinal tract, which impairs the blood supply of the colon with subsequent formation of pseudopolyps, most often develop in the pathology of the biliary system and pancreas.
The development of the disease
When pseudopolyposis the colon are formed by the protuberances that look very similar to true intestinal polyps. Morphologically, these outgrowths are sections of the mucous membrane, which grows on the background of inflammatory or infectious lesions, but the mucosa remains in its normal cellular functions. Often pseudopodia surrounded by more or less deep ulcerations and foci of superficial unexpressed of necrosis (necrosis).
Such growths may also be formed when proliferation of the glandular epithelium.
This process of proliferation is observed at the restoration of the damaged mucosa after:
- inflammatory lesions;
- the trophicity
and so on.
Sometimes the structure of pseudopolyps find not only the cells of the mucous membrane of the colon, but:
- areas of connective tissue;
Pseudopolyposis outgrowths of the mucous membrane are formed not only after inflammation, trauma or other destruction of the mucous membrane of the colon – they can also be formed in the area stretching of the intestinal wall that occurs when the peristaltic movements.
The number of spines in pseudopolyposis colon can be very different – from a few to multiple formations that cover the mucous membrane of the colon almost in its entirety. The size of pseudopolyps also vary. The most popular size of pseudopodia – 5-10 mm in diameter, but there are nodes in size and 1 mm in diameter (match head), and 5 cm in length. Described giant growths, separate outgrowths reached 7-8 cm in length.
The shape of pseudopodia do not differ in such a variety, quantity and size. They are in the form:
- algae (or worms);
- the cap of the mushroom.
Allocate a separate form pseudopolyposis colon – cystic-polypous colitis. The growths on the mucosa of the colon alternate with cyst – formations in the form of cavities with the liquid inside.
It is revealed that pseudopolyposis growths are not prone to malignancy (malignant transformation). Nevertheless the following cases: when restoring the mucous membrane of some cells formed pseudopodia, and part was undergoing a process of dysplasia (disorders of the cellular structure), and later developed into cancer cells.
Symptoms of pseudopolyposis colon
For a long time pseudoprime did not occur – the patient will experience symptoms typical of the underlying disease that triggered the development of pseudopolyps.
When pseudopolyposis which arose on the background of ulcerative colitis, perhaps the manifestation of such symptoms as:
- periodic average intensity of cramping or aching pain in the course of the colon;
- violation of the chair in the form of diarrhea;
- impurities in the stool blood, mucus and pus;
- tenesmus false urge to defecate;
- deterioration of the General condition – hyperthermia (rise in body temperature in the range from 37 to 39 degrees Celsius), weakness, decreased performance.
When pseudopolyps occurred on the background of ulcerative colitis, it is also possible extraintestinal manifestations – they manifestirutaya:
- pain in the joints (developing ankylosing spondylitis inflammatory damage to the joints, which leads to restriction of movement in them);
- inflammatory manifestations of the oral cavity (aphthous stomatitis);
- inflammation of the choroid of the eyeball (uveitis develops);
- the nodules in the skin and subcutaneous adipose tissue (nodular erythema).
In the case of pseudopolyps on a background of Crohn’s disease experiencing such symptoms:
- abdominal pain – medium-intensive, aching, regular;
- irregularity – diarrhea. Also can cause constipation – they develop due to cicatricial narrowing of the intestinal lumen, this pseudopolyps in Crohn’s disease differs from pseudopolyposis, developing on the background of ulcerative colitis;
- deterioration, and then loss of appetite;
- progressive decrease of body weight;
- the deterioration of General condition, weakness, lethargy, hyperthermia (mostly moderate – 37-37,5 degrees Celsius).
In this case, can develop the same extraintestinal manifestations, as in pseudopolyps in the background of ulcerative colitis, as well as with violations of the liver and kidneys.
If pseudopolyps developed on the background of dysentery, you experience the following symptoms:
- periodic severe stomach pains in the form of labor;
- rumbling in the intestines;
- the repeated diarrhoea (diarrhea);
- blood, mucus and pus in the stool;
- signs of intoxication hyperthermia from 37.6 to 38.5 ° C, severe weakness, dizziness.
Diagnosis of pseudopolyposis colon
As specific features of pseudopolyposis no, a diagnosis on the basis of some complaints of the patient to put difficult. It is necessary to involve all possible methods – physical, instrumental, laboratory.
Physical data of research method largely depends on the background of some of the disease experiencing the disease. The results can be the following:
- during the inspection – in case of acute inflammatory process the patient is weak, sluggish, adynamic, skin and visible mucous membranes pale, tongue coated with white bloom;
- palpation (feeling) of the abdomen have abdominal pain in the projection of the intestine, where the increased pseudopodia. When pseudopolyps on the background of dysentery during palpation of the abdomen may roar;
- percussion (tapping) of the abdomen confirmed soreness of the abdomen;
- auscultation of the abdomen (listening with a stethoscope) – in the case of severe diarrhea defines intestinal peristalsis;
- when digital examination of rectum – on the glove investigating found blood, mucus and pus.
Instrumental methods of investigation to confirm the diagnosis of pseudopolyposis colon, the following:
- colonoscopy – into the lumen of the colon introduce a colonoscope (a type of endoscope that is a flexible probe with optics and illumination at the end), through the optical system to inspect the inner surface of the colon, show signs of pathology, which occurred pathology, and pseudopolyposis expansion, evaluate their shape, size and features of the morphological structure, the presence or absence of ulceration;
- biopsy – during the colonoscopy, make the taking of tissues and outgrowths of the mucous membrane, not involved in the process, then to examine them under a microscope;
- barium enema – the colon through the anus injected contrast agent, do a series of x-ray pictures, which help assess the condition of the colonic wall, as well as reveal filling defects, which arise due to the presence of pseudopolyps.
Laboratory methods used in the diagnosis of pseudopolyposis colon, the following:
- General analysis of blood – it is not a specific research method, but detected increase in blood the number of leukocytes and ESR confirms the presence in the body (and, in particular, in the colon) inflammatory process, against which the developed pseudopolyps colon;
- histological examination of the biopsy – biopsy study of the subject tissue structure and confirm (or not confirm) the diagnosis of pseudopolyposis;
- Cytology biopsy – biopsy is studied at the level of cellular structure. The method is important in differential diagnosis of pseudopolyposis and malignant lesions of the colon;
- direct microscopic examination of the contents of the large intestine – it identify the causative agent that triggered the disease in the colon, which developed pseudopolyps;
- bacteriological examination of the contents of the colon make it an inoculation medium, the expected growth of the colonies on them identificeret of the pathogen that caused the pathology of the colon, which became the impetus for the development of pseudopolyps;
- coprogram – Calais reveal blood, mucus, pus.
Differential diagnosis of
Differential (distinctive) pseudopolyposis diagnosis of the colon is carried out with such diseases and pathological conditions, such as:
- true polyps of the colon;
- family polyposis is genetically determined the formation of many (100 to 1000) of polyps in the mucosa of the large intestine;
- colorectal cancer is a malignant tumor of any of the divisions of the colon;
- lipoma – benign tumor arising from the adipose tissue;
- carcinoid of the colon – hormonally active tumor, potentially malignant.
Complications of pseudopolyposis colon
Most often, should be wary of such complications of pseudopolyposis colon, as:
- stricture of the large intestine – contractions of the colonic wall;
- intestinal obstruction – impairment of movement of intestinal contents in the lumen of the intestine;
- intestinal bleeding;
- perforation of the colon – the formation of a defect in its wall with the release of intestinal contents into the abdominal cavity;
- peritonitis – inflammation of the sheets of the peritoneum from contact with intestinal contents they penetrated into the abdominal cavity through a perforation of the colonic wall;
- sepsis – spread of infection through the blood throughout the body with the formation of secondary purulent foci in the organs and tissues.
Treatment of pseudopolyposis colon
Treatment of pseudopolyposis depends on some disease, it has emerged.
By pseudopolyps in the background of ulcerative colitis with the following:
- drugs 5-aminosalicilova acid;
- infusion therapy – under water electrolyte disorders. Intravenously administered protein and salt solutions, glucose, electrolytes, fresh frozen plasma;
- antibacterial drugs.
When pseudopolyps in the background of ulcerative colitis also used surgical treatment. The testimony to it:
- the ineffectiveness of conservative therapy;
- dysplasia of the mucous membrane of the colon;
- the development and evolution of extraintestinal symptoms;
- the occurrence of complications.
Surgical treatment involves resection (removal) of part of the colon that is affected by pseudopolyps.
Treatment of pseudopolyposis colon arising on a background of Crohn’s disease includes the same destinations as when pseudopolyps in the background of ulcerative colitis, with the following additions:
- blockers of tumor necrosis factor;
- blockers integranova receptors;
- vitamin D;
- hyperbaric oxygenation is the saturation of tissues of the patient with oxygen, which is carried out by the method of placement of the patient in a special chamber with pressurizing it with oxygen.
Surgery is indicated under the same conditions as the operation in the case of pseudopolyposis occurred on the background of ulcerative colitis.
If pseudopolyps colon came on the background of dysentery, are assigned:
- special dietary food;
- antibacterial therapy;
- infusion therapy for the purpose of detoxification and correction of electrolyte disturbances.
Prevention of pseudopolyposis colon
At the heart of prevention – prevention of injury and the development of inflammatory processes in the colon.
Specific activities are:
- careful completion of all the manipulations in the colon to prevent injury of the mucous membrane;
- timely detection and treatment of ulcerative colitis, Crohn’s disease, and dysentery – diseases, which most often occurs pseudopolyps colon and other predisposing diseases.
- prevent constipation and the formation of fecal stones – for this you should first adjust the diet.
The prognosis for pseudopolyposis colon different. Timely surgical treatment can get rid of pseudopolyps. But since the disease often occurs against a background of ulcerative colitis and Crohn’s disease, are chronic pathologies, its possible recurrence.
Even during stable remission, patients should be under medical observation and receive supportive care.