Oncological transformation of diverticular colon disease. A combination or a regular sequential process?
Authors:   Pirogov National Medical and Surgical Center, Moscow, Levchuk A.L. , Abdullaev A.E. ,   GKB SMP, Vladimir
Published: November 2024

Objective. Improve the diagnostic capabilities and treatment results of patients with diverticular colon disease (DBTK) complicated by the development of colorectal cancer. Materials and methods. A study was conducted with the participation of 72 patients treated at the State Clinical Hospital of the NSR of Vladimir from 2013–2023 with DBTC complicated by the presence of acute colonic obstruction. There were 56 men (77.7%) and 16 women (22.2%). The average age of the patients was 56.2±11.3 years. All patients had a history of clinical manifestations of DBTC. In 98% of the cases of the studied patients, with a disease duration of more than three years, there were at least three exacerbations of acute diverticulitis of the colon during the year. The mandatory diagnostic program included: general clinical examinations, ultrasound and CT of the abdominal cavity and pelvis, Cnott irrigoscopy, fibrocolonoscopy (FCS) with histological verification. All patients, upon admission, underwent a complex of therapeutic measures aimed at resolving intestinal obstruction. In 54 (75%) patients, the obstruction was of an obstructive nature. 18 (25%) had partial colonic obstruction, which resolved after conservative treatment. Results: the main complaints of the subjects were pain in the left half of the abdomen, periodic rises in body temperature, weight loss, stool disorders such as constipation or diarrhea, blood admixture in feces. In 45 (62.5%) cases, against the background of ultrasound signs of acute diverticulitis, a tumor-like formation in the intestinal wall with signs of colonic obstruction was determined. Irrigoscopy was performed in 54 (75%) cases. In 26 (36.1%), the tumor was localized in the sigmoid colon, 9 (12.5%) – in the splenic bend of the colon, 9 (12.5%) – in the descending intestine, 10 (13.8%) – in the recto-sigmoid colon. Fibrocolonoscopy with biopsy was performed in 18 (25%) cases. Against the background of DBTC, a tumor of the sigmoid colon was detected in 10 (13.8%) patients, a tumor of the recto-sigmoid department in 3 (4.1%) cases, cancer of the descending intestine in 2 (2.7%) patients and a tumor of the splenic bend of the colon in 3 (4.1%) cases. 72 (100%) patients were operated on. The main types of surgical treatment were: obstructive resection of the sigmoid colon in 25 (34.7%) cases, resection of the sigmoid colon with the imposition of primary anastomosis in 20 (27.7%) patients, resection of the sigmoid colon with the imposition of preventive loop transversostomy in 6 (8.3%) cases, in 15 (20.8%) left-sided hemicolectomy with the imposition of primary anastomosis, left-sided hemicolectomy with Thornball preventive ileostomy was performed in 6 (8.3%) patients. Complications occurred in 6 (8.3%) cases. There were no fatalities. Conclusion: the only radical method of treatment for this category of patients is only surgical intervention. The use of modern methods of instrumental diagnostics allows you to choose the most optimal amount of surgical intervention. When detecting a combined lesion of the colon of DBTC and cancer, an intervention should be performed in compliance with oncological principles and the expansion of the boundaries of colon resection with the removal of the zone of spread of diverticulosis.