Sigmoid colon polyps are referred to as benign neoplasms consisting of glandular epithelial tissue lining the intestinal wall and growing inside the intestinal lumen.
Having mushroom-shaped, spherical and groinlike outlines, they are attached to the walls of the affected organ with a narrow leg or broad base and can eventually degenerate into malignant tumors.
Polyps localized in the sigmoid colon, there are:
- Hyperplastic. Neoplasms of this type, not exceeding five millimeters in diameter, are found in the intestine most often. The light coloration of hyperplastic polyps resembling flat spherical plaques makes them well marked against a background of darker mucous membranes. Despite the fact that hyperplastic polyps malignantly rarely( in spite of multiple manifestations), the course of the tumor process must be under the supervision of a qualified specialist.
- Adenomatous is an extremely dangerous neoplasm with a high ability to malignant degeneration during the first ten years( that's why physicians consider them a precancerous condition).The size of adenomatous polyps varies within one to five centimeters. Adenomatous polyps, in turn, are divided into tubular neoplasms, villous tumors and tubular-villous polyps. Not delivering to the patient any problems at the initial stages of their development, all of them can eventually reach large sizes and cause acute intestinal obstruction, and easily traumatized villous tumors - a source of permanent bleeding.
- Diffuse , caused by the presence of hereditary diseases, represented by the syndromes of Peitz-Jegers, Cowden, Lynch, Gardner, Tyurko, as well as juvenile and familial adenomatous polyposis. In the intestines of even very young patients who inherited this ailment, they discover an incredible number of rapidly developing tumors, counted in hundreds and even thousands.
Causes of the disease
Polyps of the sigmoid colon belong to the category of polytheological diseases that develop under the influence of several factors. Most often, their appearance is due to:
- Presence of chronic intestinal diseases( diverticulosis, Crohn's disease, chronic and nonspecific ulcerative colitis).
- Disbacteriosis, which leads to a violation of the balance of the intestinal microflora.
- Intervention of the hereditary factor: according to medical statistics, 35% of patients who have been diagnosed with polyposis of the intestine have close relatives suffering from a similar pathology.
- Affiliation to the male sex: statistical evidence supports the fact that polyps in the sigmoid colon are found in the stronger sex more than three times more often than in women.
- A sedentary lifestyle and a lack of physical activity. Due to this factor, the development of obesity and a significant deterioration of intestinal peristalsis, fraught with the occurrence of frequent constipation and inflammatory processes in the tissues of the mucous membrane of the sigmoid colon.
- An unbalanced diet containing insufficient amount of plant fiber, resulting in decreased intestinal motility and the time of exposure of carcinogens contained in stagnant stool to the tissues of the mucous membrane of the sigmoid colon. The number of carcinogens, which are bile acids and their derivatives, significantly increases in the body of people who consume too much fatty foods, meat and confectionery, for the digestion of which requires a significant amount of bile.
Clinical symptoms of polyps in the sigmoid colon
Symptomatic, directly indicating the presence of polyps in the sigmoid colon( this particularly applies to single malignancies that rarely cause discomfort) is so meager that a sick person can not even guess for a long time about his illness.
Practical absence of external manifestations is the reason that the disease is most often detected during a survey undertaken for a very different ailment.
The presence of multiple neoplasms can become a source of significant discomfort. The first clinical symptoms appear after the polyp has reached significant( more than 3 cm) in size.
The initiated polyposis of the sigmoid colon is accompanied by the following manifestations:
- Every attempt by the patient to sit down or perform a sharp movement can be accompanied by severe itching and sharp pain in the lower abdomen.
- In the presence of villous polyps, permeated with a variety of blood vessels and tending to damage, even with little contact with the calves passing through their affected intestine, the patient notices the appearance of blood or blood clots in their own feces. In cases of severe ulceration of villous tumors, significant bleeding may develop during the act of defecation. In rare cases, when blood loss is up to one and a half liters, it can even threaten the life of a sick person.
- The glandular polyps provoke the appearance of a large amount of mucus in the stool. Sometimes a chair can consist of mucus alone.
- Since certain types of polyposis are accompanied by a copious discharge of fluid into the lumen of the sigmoid colon, the clinical course of the disease is characterized by a constant alternation of constipation and diarrhea attacks. Symptoms of intestinal dyspepsia are often supplemented by false urge to excrement.
- The ill person notes a constant eructation, heartburn, bloating and an intensified flatulence.
- Large neoplasms, reaching an impressive size, can fall out of the body of a sick person through the anus.
- The last stages of polyposis are accompanied by a significant deterioration in the patient's condition: it develops acute intestinal obstruction, increased fatigue and extreme muscle weakness, severe headaches and elevated body temperature are not uncommon.
In the case of complete absence of clinical manifestations of polyposis a person can live to old age without even suspecting the presence of polyps in the intestine. Most likely, the benign neoplasms at it or him and will not be revealed.
The first step in the diagnosis of sigmoid colon polyps is a physical examination of the patient, consisting of:
- Anamnesis collection, during which the doctor will ask the patient for complaints, previous illnesses, lifestyle and diet. The patient will necessarily be asked about the presence of close relatives who have ever had an intestinal disease.
- Finger examination of the lower part of the rectum, allowing to identify the neoplasms present in it or to be convinced of their absence.
Instrumental diagnostics is carried out by methods:
- Colonoscopy is an endoscopic study performed with a colonoscope. This tool is a flexible and very thin metal tube, equipped with a backlight and a fiber optic video camera, which allows you to display the image on the monitor. The length of the device, introduced into the patient's body through the anus, makes it possible to visually inspect all parts of the intestine - from the anal canal to the caecum. To improve the quality of the examination and spread the folds of the intestine, with the help of a special tube, the doctor injects air into the cavity of the examined intestine. Having found out any neoplasm, the expert takes a biopsy - plucking off of him a tiny piece of tissue, using biopsy forceps. The obtained samples are immediately sent to the laboratory to exclude the presence of cancer cells in them. Small benign neoplasms can be removed already during the diagnostic study, in this case the colonoscopy simultaneously performs the role of surgical intervention. Given the high morbidity of the procedure, the patient must be anesthetized.
- A less informative method is the almost identical procedure of sigmoidoscopy, performed with the scanner( this device also has a video camera, illumination device and biopsy forceps).Recto-manoscopy allows you to examine a limited area of the intestine, which includes the entire rectum and the initial section of the sigmoid.
- For inspection of the mucous membranes of the rectum and sigmoid colon, the sigmoidoscopy procedure can be performed by carefully inserting the sigmoidoscope into the intestine of the patient( through the anus, a distance not exceeding 60 cm).With this study, considered more sparing than a colonoscopy, it is possible to detect almost 90% of the pathological processes occurring in the cavity of the rectus and sigmoid colon. The main drawback of this method is the impossibility of detecting tumors not exceeding one centimeter in diameter.
- Irrigoscopy - X-ray study consisting in the introduction of radiopaque substance - barium sulfate in the cavity of the large intestine and performing X-rays. The method of double contrasting, which involves the simultaneous introduction of barium suspension and the injection of air into the lumen of the intestine, which spreads the folds of the mucosa, significantly improves the quality of the radiographs obtained. Neoplasms located on the walls of the intestine, on X-ray images look like defects in its filling.
Fecal occult blood test is an indirect confirmation of the presence of polyps in the patient's body, so it must be included in the diagnostic examination program.
Treatment of polyps in the sigmoid colon
Since the drug treatment of polyposis of the sigmoid colon does not give any results, it is possible to get rid of tumors in the intestine only by their radical removal.
Modern surgeons perform this method:
- Colonoscopic or sigmoidoscopic polypectomy followed by electrocoagulation of the bed;
- Transanal excision;
- Endoscopic removal;
- Resection of the sigmoid colon;
- Radical removal.
The essence of this technique is the following: a loop electrode is fed to the detected tumor, which is attached to the intestinal wall by means of a thin pedicle, through a special channel of the operating endoscope.
Tightly grasping and looping the leg of the polyp, achieve complete cessation of blood flow, after which a high-frequency current is passed through the electrode.
A few seconds of exposure is usually enough to cut off the head of the polyp and get charring of its leg. The body of the removed polyp is immediately removed from the patient's body by sucking to the endoscope or with the help of clamshell forceps, and the bed of the removed tumor is further cauterized.
This is the case with regard to small lesions on a thin stalk. If the leg of the polyp was rather thick, the surgeon cuts off the polyp gradually, changing the cutting tactics and coagulation regimes.
Polypectomy of large lesions with a wide base is carried out in several stages. Duration of interruptions between surgical interventions can be from two to three weeks: during this time, the wounds remaining after surgical intervention, have time to tighten.
Endoscopic polypectomy, perfectly tolerated by patients, is a gentle procedure, after which a person does not need a rehabilitation period and can engage in regular labor activity the very next day after the operation.
Transanal excision of
Transanal excision of the polyp through an enlarged lumen of the rectum. This type of surgery is performed under local anesthesia.
After the injection of novocaine, the surgeon stretches the anal canal using a rectal mirror. The neoplasm, intercepted by the clamp, is cut off, and the formed defect of the mucous lining of the intestine is sutured. Removal of polyps, having a wide base, is produced with the help of a scalpel within the limits of healthy tissues.
Given the difficulty of completely removing neoplasm, carried out in this way and therefore fraught with a high probability of relapse, this technique is not always appropriate.
Endoscopic excision of sigmoid and rectum neoplasms carried out using an operating rectoscope equipped with two eyepieces( viewing and working) and microsurgical instruments.
During this endomicrosurgical intervention, hyperplastic and adenomatous polyps and villous tumors located within 20 cm from the anus are excised( within healthy tissues).The defect of the intestinal wall, formed as a result of the operation, is immediately restored.
Resection of the sigmoid colon together with detected neoplasms followed by anastomosis between healthy edges of the intestine.
This type of treatment, requiring the execution of a cavitary operation under general anesthesia, is used for the multiple nature of polyps, their severe ulceration or the tendency to merge.
Radical removal of
If a histological examination of the tissues of the removed lesions revealed the presence of cancer cells, the radical removal of the affected sigmoid colon together with the regional lymph nodes is performed, and then the colostoma is formed.
Diet after removal of
formation After the removal of polyps of the sigmoid colon, the maintenance of a sparing diet is essential for the rapid and successful recovery of the patient, which excludes the possibility of relapses. Its main purpose is to prevent the occurrence of constipation and conditions that provoke irritation of the intestinal walls.
How to organize a diet for a patient who underwent a polypectomy surgery?
- Its daily ration should contain at least six meals, eaten at regular intervals. The volume of one serving should be such that the product used fits in handfuls.
- All dishes are prepared by cooking, quenching and steaming. Fried food is under strict prohibition.
- Substantially limited the amount of salt added to dishes.
- It is unacceptable to drink excessively hot and too cold food and drinks.
- Use of sharp, acidic and salty products is strictly forbidden.
- Solid food should be passed through a meat grinder or a small grater.
- Any porridge should be wiped through a sieve or grinded in a blender.
A person suffering from polyposis is strictly prohibited from consuming:
- Fatty varieties of fish, poultry and meat.
- Any cabbage. Radish and radish.
- Canned food and marinades.
- Buying sauces( especially ketchup and mayonnaise).
- Strong coffee.
Strict adherence to the diet is recommended to the patient during the first month after the operation. The positive result of the control endoscopic examination is the basis for some mitigation of the requirements for nutrition of the operated person.
Consequences of the disease
Polyps of the sigmoid colon are capable of:
- Reborn in malignant tumors.
- To become responsible for anorectal bleeding due to traumatization of neoplasms( especially villous tumors).
- Provoke acute intestinal obstruction due to congestion of the lumen of the affected bowel overgrowth.
- Lead to the development of acute enterocolitis - a dangerous condition characterized by inflammation of the intestinal wall. In the case of rapid progression, enterocolitis can result in the death of a sick person.
- Cause anemia due to persistent bleeding.
No one insures against the appearance of polyps in the sigmoid colon, but the implementation of a number of simple rules can reduce this risk at times:
- When symptoms of polyposis appear( especially the mucus and blood mucus admixture should be alerted), every person should immediately consult a proctologist andundergo a diagnostic examination.
- In case of detection of benign neoplasms, it is necessary to go through the procedure for their removal as soon as possible.
- The complete refusal of alcohol and smoking will reduce the content of carcinogenic substances that enter the human body and contribute to the development of polyposis.
- The correct nutrition, abundant in fresh herbs, vegetables and fruits, containing a large amount of vegetable fiber, is of great importance in the prevention of polyposis. The category of useful products include lean varieties of fish and meat, whole grain bread and vegetable oils. People who are trying to prevent the development of polyposis should once and for all exclude from their diet acute, smoked, fatty and fried foods, fast food( especially fast food), canned food and pickles, coffee and carbonated drinks, fresh pastries and high-calorie confectionery.
- The use of a large( up to 1.5 liters) of drinking water, green tea and juices, which contributes to the normalization of digestion, is also a good prevention of the occurrence of benign neoplasms.
- Everyone should strive to normalize weight and prevent obesity.