Polyp 5 mm of the sigmoid colon. Symptoms of sigmoid colon polyps, causes, treatment regimen and diagnostic methods. Complete or partial resection of the sigmoid colon

Polyps are small, benign tumors located in the sigmoid colon, large intestine, or rectum. Polyps can form either in groups or singly and are more common in older people.

The main danger of a sigmoid colon polyp is that the neoplasm can degenerate into malignant tumor and lead to colon cancer. The tumor may have a stalk and a body located at some distance from the intestinal mucosa. Polyps are often identified in the form of growths, located in groups and tending to merge over time. Removing such tumors is the most labor-intensive process.

Types of polyps

Doctors differentiate three types of sigmoid colon polyps:

1. Hyperplastic polyp - the most common type benign tumors large intestine. The size of such a polyp is small: 1 – 5 mm. The tumor itself is relatively safe, but requires regular monitoring.
2. Adenomatous polyp - dangerous species intestinal neoplasms. The risk of developing bowel cancer within 5 to 10 years of the polyp's existence is quite high. The size ranges from 10 to 50 mm.
3. Polyposis syndrome, in which people are diagnosed at a fairly young age great amount polyps in the intestines. The cause of the development of polyposis syndrome is heredity (Lynch syndrome, Gardner syndrome, Cowden syndrome, etc.).

Reasons for the formation of polyps

Tumors in the large intestine appear for the following reasons:

• poor heredity (if one of your close relatives had intestinal cancer, the likelihood of inheriting this disease increases several times);
• Not proper nutrition(excess animal proteins, systematic consumption of fast food and processed foods, few vegetables and fruits in the daily diet);
• chronic constipation.

Symptoms

In more than half of the patients with polyps in the sigmoid part of the large intestine, the tumors did not make themselves felt at all. The second half of the patients complained about:

• discharge of blood with feces from the anus;
• separation of mucus with stool;
• constipation;
• chronic diarrhea.

Diagnosis

A gastroenterologist diagnoses intestinal polyps. The doctor is obliged to prevent the development of intestinal cancer by identifying polyps at an early stage. To do this, the patient must undergo the following studies:

• stool analysis to detect blood particles;
• contrast X-ray of the intestines (irrigoscopy);
• examination of the lower third of the rectum using fingers;
• sigmoidoscopy - examination of the lower intestine using a tube with a light diode inserted into the anus;
• colonoscopy – endoscopic examination of the intestines.

Colonoscopy is recommended regularly for those people whose age has reached the 50-year mark. In cases of familial polyposis syndrome, colonoscopy must be performed annually starting from the age of 30. Such requirements are due to the high probability of polyps (especially multiple ones) degenerating into intestinal cancer, which often leads to death.

Treatment of the disease

Polyps are treated surgically. Drug treatment and physical therapy have practically no effect on them. Removal of a sigmoid colon polyp occurs using a special endoscope equipped with a loop-shaped electrode. This loop is placed around the tumor stalk, pinches it and quickly cuts it off. The wound is cauterized using electrocoagulation. The operation is well tolerated by patients and does not require anesthesia; removal of polyps is painless. The next day after the manipulations, the patient is allowed to go home. If there are many polyps or they tend to merge, the patient is indicated for abdominal surgery to remove the affected part of the intestine. After the polyp is removed, it is sent for a biopsy. Colonoscopy has a fairly high probability of repeated relapses: in 15% of patients, polyps reappear in the intestines.

Diet after polyp removal

Compliance with a specialized nutrition system, adapted specifically for patients with mechanical intestinal injuries, will help avoid relapses of the disease. Basic nuances of patient nutrition:

• it is necessary to try to minimize the consumption of table salt;
• exclude spicy, salty, sour foods;
• It is forbidden to eat/drink too hot or cold;
• It is recommended to eat 6 – 7 times a day in small portions (ideal if the amount of food fits in the palm of your hand);
• Eating fried foods is strictly prohibited;
• all food should be boiled/stewed/steamed;
• solid food must be passed through a meat grinder, blender or grater;
• a couple of times a week you can allow yourself to drink a cup of weakly brewed black tea or cocoa;
• All porridges must be ground through a metal sieve or passed through a blender.

What is strictly prohibited?

• Mushrooms in any form;
• fatty meat, poultry and fish;
• canned and pickled foods (vegetables, fruits, fish, meat, poultry);
• coffee;
• all varieties of cabbage;
• radish, radish;
• store-bought ready-made sauces (ketchups, mayonnaise, etc.).

Sigmoid colon polyps are benign neoplasms consisting of glandular epithelial tissue lining the intestinal wall and growing inside the intestinal lumen.

Having mushroom-shaped, spherical and grape-shaped outlines, they are attached to the walls of the affected organ using a narrow stalk or wide base and can eventually degenerate into malignant tumors.

Kinds

Polyps localized in the sigmoid colon are:

• Hyperplastic. Neoplasms of this type, not exceeding five millimeters in diameter, are most often found in the intestines. The light color of hyperplastic polyps, resembling flat spherical plaques, makes them clearly visible against the background of darker mucosa. Despite the fact that hyperplastic polyps become malignant extremely rarely (despite multiple manifestations), the course of the tumor process should be under the supervision of a qualified specialist.
• Adenomatous– extremely dangerous neoplasms that have high ability to malignant degeneration within the first ten years (which is why doctors consider them a precancerous condition). The size of adenomatous polyps ranges from one to five centimeters. Adenomatous polyps, in turn, are divided into tubular neoplasms, villous tumors and tubular-villous polyps. Although they do not cause any problems to the patient in the initial stages of their development, all of them can eventually reach large sizes and become the cause of acute intestinal obstruction, and easily injured villous tumors can become a source of constant bleeding.
• Diffuse, caused by the presence of hereditary diseases represented by Peutz-Jeghers, Cowden, Lynch, Turcot syndromes, as well as juvenile and familial adenomatous polyposis. In the intestines of even very young patients who have inherited this disease, an incredible number of rapidly developing neoplasms, numbering in the hundreds and even thousands, are found.

Causes of the disease

Polyps of the sigmoid colon belong to the category of polyetiological diseases that develop under the influence of several factors. Most often their appearance is due to:

• The presence of chronic intestinal diseases (and nonspecific).
• leading to imbalance of intestinal microflora.
• Intervention of a hereditary factor: according to medical statistics, 35% of patients who have been diagnosed with intestinal polyposis have close relatives suffering from a similar pathology.
• Belonging to the male sex: statistical data support the fact that polyps in the sigmoid colon are found in the stronger sex three times more often than in women.
• Sedentary lifestyle and lack of physical activity. Due to this factor, obesity develops and a significant deterioration in intestinal motility occurs, 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 amounts of plant fiber, as a result of which intestinal motility decreases and the time of exposure to carcinogenic substances contained in stagnant food increases. feces ah, on the tissue of the mucous membrane of the sigmoid colon. The amount of carcinogens, which are bile acids and substances derived from them, increases significantly in the body of people who consume too many fatty foods, meat and confectionery products, which require digestion. significant amount bile.

Clinical symptoms of polyps in the sigmoid colon

Symptoms that directly indicate the presence of polyps in the sigmoid colon (this is especially true for single tumors that rarely cause discomfort) are so scarce that a sick person may not even be aware of his illness for a long time.

The practical absence of external manifestations is the reason that the disease is most often detected during an examination undertaken for a completely different ailment.

The presence of multiple tumors can be a source of significant discomfort. The first clinical symptoms appear after the polyp has reached a significant (more than 3 cm) size.

Advanced sigmoid colon polyposis is accompanied by the following manifestations:

• Every attempt by the patient to sit down or make a sudden movement may be accompanied by severe itching and sharp pain in the lower abdomen.
• In the presence of villous polyps, penetrated by many blood vessels and having a tendency to be damaged even with slight contact with feces passing through the intestine affected by them, the patient notices the appearance of blood threads or blood clots in his own feces. With severe ulceration of villous tumors, significant bleeding may develop during 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.
• Glandular polyps provoke the appearance of large amounts of mucus in the stool. Sometimes the stool may consist of only mucus.
• Because the individual species polyposis is accompanied by abundant fluid secretion into the lumen of the sigmoid colon; the clinical course of the disease is characterized by a constant alternation of constipation and bouts of diarrhea. Symptoms of intestinal dyspepsia are often supplemented by a false urge to defecate.
• A sick person notices constant belching, heartburn, bloating and increased flatulence.
• Large neoplasms that have reached impressive sizes 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: he develops acute, increased fatigue and extreme muscle weakness, often severe headaches and elevated body temperature.

Diagnostics

In case of complete absence clinical manifestations a person can live to an old age without even knowing that they have polyposis. Most likely, benign neoplasms will never be detected in him.

If the patient has any problems with proctology, he will definitely be prescribed diagnostic examination, which consists of a series of laboratory and instrumental studies.

The first step in diagnosing sigmoid colon polyps is a physical examination of the patient, consisting of:

• Taking an anamnesis, during which the doctor will ask the patient about the presence of complaints, previous diseases, his lifestyle and diet. The patient will definitely be asked about the presence of close relatives who have ever suffered from intestinal diseases.
• Digital examination of the lower part of the rectum, allowing to identify neoplasms present in it or to ensure their absence.

Instrumental diagnostics are carried out using the following methods:

• Colonoscopy– endoscopic examination performed using a colonoscope. This instrument is a flexible and very thin metal tube equipped with a light and a fiber-optic video camera that allows you to display the image on a monitor. The length of the device, inserted into the patient’s body through the anus, allows for a visual inspection of all parts of the intestine - from the anal canal to the cecum. To improve the quality of the examination and straighten the folds of the intestine, using a special tube, the doctor pumps air into the cavity of the intestinal section being examined. Having discovered any neoplasm, the specialist takes a biopsy - pinches off a tiny piece of tissue from it, using biopsy forceps. The resulting samples are immediately sent to the laboratory to exclude the presence of cancer cells. Small benign tumors can be removed during a diagnostic study; in this case, colonoscopy simultaneously plays the role of a surgical intervention. Given the high pain of the procedure, the patient must be anesthetized.
• A less informative method is the almost identical sigmoidoscopy procedure, performed using a sigmoidoscope (this device also has a video camera, a lighting device and forceps for performing a biopsy). allows you to inspect limited area intestine, including the entire rectum and the initial part of the sigmoid.
• A sigmoidoscopy procedure may be prescribed to examine the mucous membranes of the rectum and sigmoid colon., carried out by carefully inserting a sigmoidoscope into the patient’s intestines (through the anus, at a distance not exceeding 60 cm). With the help of this study, which is considered more gentle than colonoscopy, it is possible to detect almost 90% of the pathological processes occurring in the cavity of the rectum and sigmoid colon. The main disadvantage of this method is the inability to detect tumors not exceeding one centimeter in diameter.
• Irrigoscopy- X-ray examination, consisting of the introduction of a radiopaque substance - barium sulfate into the cavity of the large intestine and x-rays. The double contrast method, which involves the simultaneous introduction of a barium suspension and the pumping of air into the intestinal lumen, straightening the folds of the mucosa, can significantly improve the quality of the obtained radiographs. Neoplasms located on the intestinal walls, on x-rays look like defects in its filling.

Stool analysis occult blood 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 drug treatment for sigmoid colon polyposis does not produce any results, the only way to get rid of neoplasms in the intestine is through them.

Modern surgeons do this using the following methods:

• Colonoscopic or sigmoidoscopy polypectomy followed by electrocoagulation of the bed;
• Transanal excision;
• Endoscopic removal;
• Resection of a section of the sigmoid colon;
• Radical removal.

Polypectomy

The essence of this technique is as follows: a loop electrode is applied to the detected tumor, which is attached to the intestinal wall with a thin stalk, through a special channel of the operating endoscope.

By tightly grasping the leg of the polyp and tightening it with a loop, a complete cessation of blood flow is achieved, 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 char its stem. The body of the removed polyp is immediately removed from the patient’s body by suction to the endoscope or using grab forceps, and the bed of the removed tumor is additionally cauterized.

This is not the case with neoplasms. large sizes on a thin leg. If the stalk of the polyp turns out to be quite thick, the surgeon cuts off the polyp gradually, changing the cutting tactics and coagulation modes.

Diet after tumor removal

After removal of sigmoid colon polyps, the key to a quick and successful recovery of the patient, eliminating the possibility of relapses, is to follow a gentle diet. Its main purpose is to prevent constipation and conditions that provoke irritation of the intestinal walls.

How to organize nutrition for a patient who has undergone polypectomy surgery?

• His daily diet should contain at least six meals, eaten at regular intervals. The volume of one serving should be such that the product consumed fits into a handful.
• All dishes are prepared by boiling, stewing and steaming. Fried foods are strictly prohibited.
• The amount of table salt added to dishes is significantly limited.
• It is unacceptable to consume excessively hot or too cold food and drinks.
• The consumption of spicy, sour and salty foods is strictly prohibited.
• Solid food should be passed through a meat grinder or fine grater.
• Any porridge should be rubbed through a sieve or crushed in a blender.

A person suffering from polyposis is strictly prohibited from consuming:

• Fatty fish, poultry and meat.
• Any cabbage.
• Radishes and radishes.
• Canned food and marinades.
• Store-bought sauces (especially ketchup and mayonnaise).
• Strong coffee.

Strict adherence to the diet is recommended for the patient during the first month after surgery. A positive result of a control endoscopic examination is the basis for some mitigation of the nutritional requirements for the operated person.

Consequences of the disease

Polyps of the sigmoid colon are capable of:

• Reborn into .
• Become the culprits of anorectal bleeding due to traumatization of neoplasms (especially villous tumors).
• Provoke acute intestinal obstruction caused by blockage of the lumen of the affected intestine by an overgrown neoplasm.
• Lead to the development of an acute - dangerous condition characterized by inflammation of the intestinal wall. In case of rapid progression, enterocolitis can result in the death of the sick person.
• Cause anemia due to constant bleeding.

A polypectomy operation with electrocoagulation of the bed of a removed tumor can lead to perforation of the intestinal wall. Despite the fact that the intestines of a patient who has undergone special preoperative preparation contain only gases, if this complication occurs, a set of measures are taken to prevent peritonitis - inflammation of the peritoneum.

Prevention

No one is immune from the occurrence of polyps in the sigmoid colon, but following a number of simple rules can reduce this risk significantly:

• If symptoms of polyposis appear (the admixture of mucus and blood in the stool should be especially alarming), each person should immediately consult a proctologist and undergo a diagnostic examination.
• If benign tumors are detected, it is necessary to go through the procedure for their removal as soon as possible.
• A complete abstinence from alcohol will reduce the content of carcinogenic substances that enter the human body and contribute to the development of polyposis.
• Proper nutrition, rich in fresh herbs, vegetables and fruits containing large amounts of plant fiber, is of great importance in the prevention of polyposis. The category of healthy foods includes lean varieties of fish and meat, whole grain bread and vegetable oils. People seeking to prevent the development of polyposis should once and for all exclude from their diet spicy, smoked, fatty and fried foods, fast food (especially fast food), canned food and pickles, coffee and carbonated drinks, fresh baked goods and high-calorie confectionery .
• Drinking large quantities (up to 1.5 l) drinking water, green tea and juices, which helps normalize digestion, is also a good prevention of the occurrence of benign neoplasms.
• Every person should strive to normalize weight and prevent obesity.

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 the left half of the colon, sigmoid and rectum are most often affected. 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 adjustment 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 risk of developing a 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 the 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 influence of various environmental conditions and lifestyle, but due to the asymptomatic course, it is possible to establish exact reason polyp is almost impossible. 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. Such a serious disease as 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. To digest 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 contractile function intestines, 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, poor and irregular diet, and abuse of certain types of foods 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. The histological structure of 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:

1. Glandular, making up more than half of all neoplasms.
2. Glandular-villous.
3. Villous.
4. 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 big number blood vessels, easily ulcerate and bleed. 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 children and at a young age. Their source is considered to be the remains of embryonic tissue. A juvenile polyp can reach 5 centimeters or more, 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, intense abdominal pain, vomiting, dry mouth, and signs of intoxication will appear.

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. Excretion of blood in large quantities - alarming symptom, requiring 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:

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

Treatment of intestinal polyps

Treatment of intestinal polyps is only surgical. No conservative therapy or promising traditional medicine can 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 is permissible only as a preparatory stage for surgical intervention and to relieve negative symptoms of the tumor.

After the polyp is removed, it is mandatory undergoes 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 put into medicated sleep, depending on the specific clinical situation. The procedure is performed on an outpatient basis. 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 no obvious signs of 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 simultaneously 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, whose skill and accuracy of actions determine the result and the possibility of dangerous complications (intestinal perforation, bleeding).

For polyps in the rectum located at a distance of no more than 10 cm from the anus, 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 is given general anesthesia, during which the surgeon dissects the anterior abdominal wall, isolates a section of the intestine, makes an incision in it, finds, examines the tumor 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 of a 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. The action of 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 of benign tumors, 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:

1. The diet should include fresh vegetables, fruits, grains, 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);
2. It is necessary to exclude alcohol and smoking;
3. An active lifestyle and adequate physical activity, normalization of weight in case of obesity are required;
4. Timely treatment of diseases of the digestive system and prevention of constipation;
5. 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 folk remedies has no scientific basis and does not bring the desired result to patients who refuse tumor removal. 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 the means traditional medicine can only be of an auxiliary nature after surgery, but only in agreement with the doctor. If it's hard to resist folk recipes, then decoctions of chamomile or calendula, including with vegetable oil, which can have an antiseptic effect and facilitate the process of bowel movements, can be safe.

Video: polyps in the intestines in the program “About the Most Important Thing”

Video: polyps in the intestines in the program “Live Healthy!”

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Previously, it was believed that removal of polyps in the intestine was advisable only for large or multiple neoplasms. However, statistics on the degeneration of these benign tumors into malignant ones (10-30% of cases) showed specialists that for cancer prevention it is important to get rid of even small polyps.

Today, endoscopic treatment is used to remove polyps in the large and small intestine, except in cases where the tumor is located in parts of the intestine inaccessible to the endoscope. Large and multiple polyps, high risk degeneration into cancer is an indication for segmental resection surgery.

Treatment tactics

If a small polyp is detected, watchful waiting may be prescribed– the doctor monitors the dynamics of tumor growth throughout the year, and if no significant changes are detected, surgery to remove polyps is not performed. However, in this case, it is imperative to continue to be examined regularly in order to eliminate the risk of degeneration in time.

Due to the psychology of Russian patients, in most cases, endoscopic removal is immediately prescribed instead of expectant management. People believe that there is no need to worry about small polyps and ignore doctors’ orders for repeated examinations, so specialists immediately take a radical approach to the problem - this is the safest option. Even a small tumor can quickly become malignant.

There is no conservative treatment for intestinal polyps - it is simply ineffective.

If there are others possible complications polyps - bleeding, incessant diarrhea, profuse mucus secretion or severe inflammatory processes - wait-and-see tactics are not used, surgery is prescribed immediately.

Removal of polyps in the colon

In most cases, removal of polyps in the rectum with an uncomplicated course is carried out endoscopically during colonoscopy. The same treatment is used for sigmoid colon polyps. The operation is called polypectomy.

Preparing for surgery

In preparation for surgery, it is necessary to cleanse the intestines. To do this, the patient is advised to drink at least 3.5 liters the day before the procedure. clean water, nutrition includes only liquid, light foods. The evening before the procedure you should not eat or drink. A cleansing enema may be prescribed.

Sometimes it is prescribed to use special solution with water and laxative. Most often this is a solution of polyethylene glycol (4 liters), which is drunk for 180 minutes the evening before surgery, or lactulose preparations (solutions of Duphalac or other medications containing this component). In the second case, 3 liters of liquid are divided into two doses - before lunch on the day before surgery and in the evening. After taking these solutions, you should experience diarrhea, possibly bloating and painful sensations in a stomach.

If the patient is taking blood thinning medications (Aspirin, Warfarin, Ibuprofen, etc.), it is important to inform the attending physician. Most likely, you will have to give them up 1-2 days before the colonoscopy.

Carrying out a polypectomy

colonoscopy

Colonoscopy is performed only in specially equipped rooms. The patient lies on the couch with his left side, and anesthetic drugs are administered. Access to the polyps is carried out through the anus; a flexible and thin endoscope (colonoscope) with a small flashlight and a video camera is inserted into it, which allows you to visually monitor the progress of the operation.

If the polyp is flat, a special drug (often adrenaline) is injected into it, which lifts it above the surface of the mucosa. The tumor is removed using an instrument with a diathermic loop at the end. They pick up the base of the polyp and cut it, while simultaneously influencing electric shock to cauterize the damaged area and prevent bleeding.

Important! The excised polyps are necessarily sent for histological analysis, only after which a final diagnosis is made. If atypical cells are detected, indicating tumor malignancy, the patient is prescribed a partial intestinal resection.

In rare cases, laser surgery is used to remove polyps. It is not as effective as colonoscopy, since it is not possible to obtain tissue material for histology (the polyp is simply burned to the root) and there are difficulties with visual control (due to smoke).

Transanal excision of polyps

If colonoscopic surgery is not possible, direct surgery through the anus may be prescribed. This treatment is not possible if the polyps are located further than 10 cm from the anus.

Before the operation, local anesthesia is performed according to Vishnevsky, and sometimes general anesthesia is prescribed. A rectal speculum is inserted into the anus. The base/leg of the polyp is excised with special instruments (Billroth clamp), the wound is sutured with 2-3 catgut knots.

If the polyp is located in the interval of 6-10 cm from the hole, then during the operation, after inserting the rectal speculum, the sphincter is relaxed with the fingers, after which a large gynecological speculum is inserted, which is used to move the intestinal wall not affected by polyps to the side. Then a short mirror is inserted and the tumor is removed using the same procedure. Polyps are sent for histology.

Segmental resection of the large intestine

This operation is prescribed only if there is a high risk of malignancy of the colon tumor or the presence of multiple closely located polyps. It is performed under general anesthesia. Depending on the location of the tumors, the type of operation is chosen:

• Anterior rectal resection. Prescribed for tumors above 12 cm from the anus. The doctor removes the affected parts of the sigmoid and rectum, and then sews the remaining parts of the intestine together. Nerve endings, healthy urination and sexual function are preserved, feces are kept normally in the intestines.
• Low front. It is used when the tumor is located 6-12 cm from the anus. Part of the sigmoid colon and the entire rectum are removed, but the anus is preserved. A temporary “reservoir” is formed to hold the stool and a stoma (part of the intestine is drained out through the peritoneum) that prevents excrement from entering the healing sutured area of ​​the intestine. After 2-3 months, a reconstructive operation is performed to close the stoma and return normal bowel function.
• Abdominal-anal. It is carried out when the tumors are located at a distance of 4-6 cm from the anus. Part of the sigmoid colon, the entire rectum, and possibly part of the anus are removed. A stoma is formed, which is closed after 2-3 months.
• Abdominoperineal. Indicated when the tumor is located close to the anus. Part of the sigmoid colon, the entire rectum, anus and part of the pelvic floor muscles are removed. A permanent stoma is formed, since it is impossible to maintain the function of normal bowel movement (the sphincter is cut out).

Important! When a permanent stoma is opened, the patient is given recommendations on its care and organization. life activities. In most cases it is possible to achieve High Quality life, despite the inconvenience and aesthetic defect.

Treatment of polyps in the small intestine

Single small pedunculated polyps of the small intestine are removed using enterotomy; in the presence of other neoplasms, resection of the small intestine is indicated.

Performing an enterotomy

This surgery is dangerous and much more serious than endoscopic methods and requires highly qualified surgeons. Stages of implementation:

1. The patient is placed under general anesthesia.
2. A transverse incision is made over the desired area of ​​the small intestine with a scalpel or electric knife.
3. Polyps are excised through the incised area and sent for histology.
4. All incisions are sutured.

After the operation, the patient must remain in the hospital under the supervision of a surgeon and gastroenterologist. Bed rest is required, painkillers are prescribed to relieve pain, and a strict diet is followed. If the doctor is insufficiently professional, narrowing of the small intestine and bleeding may occur.

Segmental resection of the small intestine

The operation is performed open or laparoscopically, the latter is preferable because it has less negative consequences– the scars are smaller, the likelihood of infection is lower, the patient’s recovery is quick. Preparation for the intervention is carried out according to the standard scheme described above. Execution proceeds as follows:

The operation lasts up to 3 hours, after which the patient is gradually removed from anesthesia (up to 2 hours). Recovery requires 3-7 days in hospital. During resection open type One large incision of the peritoneum is performed, rehabilitation requires up to 10 days in the hospital, otherwise there are no differences.

Rehabilitation period

Within 2 years after removal of polyps, the risk of relapse and bowel cancer is high. Patients are shown undergoing regular examinations– every 3-6 months. The first examination is scheduled 1-2 months after the operation. Subsequently (from the third year after treatment), examinations are required every 12 months.

• Do not ignore preventive examinations, come to the doctor at the appointed time, follow his recommendations.
• Give up bad habits; smoking and drinking alcohol are extremely undesirable.
• You should not engage in heavy physical labor or lift weights - this will increase the risk of bleeding.
• Avoid hypothermia and overheating, do not stay in the sun for a long time, avoid solariums and follow the prescribed hygiene measures.
• Try to limit stress and prevent overwork. Healthy rest plays a significant role in recovery.

During the rehabilitation period it is necessary to follow a diet. During the first week after endoscopic surgery, you should eat chopped food, purees, soft liquid porridge. Tough and difficult to digest foods rich in coarse fiber are excluded. Meals should be fractional - eat up to 6 times a day.

Important! After open operations The diet is prescribed by a doctor, it is very strict and excludes almost all food.

You will need to see a doctor immediately if you have the following complications:

• Fever, chills;
• Heaviness in the abdomen, nagging pain;
• Redness, swelling in the anus;
• Blackening of the stool, blood during bowel movements, constipation;
• Nausea, vomiting and other signs of intoxication.

This may indicate dangerous consequences operations, which include bleeding, perforation of the intestinal wall, intestinal obstruction, enterocolitis, formation of fecal stones or malignancy.

Average prices

The cost of operations to remove polyps in the intestines varies greatly depending on the clinic, the doctor’s qualifications and the amount of work. The approximate price range is presented in the table.

Free treatment is possible in public clinics under the compulsory medical insurance policy. Help under the VMP program is also possible if the malignancy of the polyp is confirmed.

Patient reviews often mention doubts about the need for surgery to remove polyps in the intestines. However, doctors unanimously argue that its implementation is justified, since it significantly reduces the risk of developing cancer. People who have undergone minimally invasive surgery are satisfied with the results and speed of rehabilitation. The main thing in treatment is to find an experienced and reliable doctor whose help you can rely on.

Video: endoscopic removal of intestinal polyps

Video: colon polyps in the program “About the Most Important Thing”

Represented as a sigma - letter Greek alphabet. Diseases lead to disruption of the digestive system and the performance of nearby organs.

A polyp in the sigmoid colon is a common disease, representing a growth on the inner wall. The tumor tissue is glandular epithelium, which is covered by a mucous layer. There are 2 types: spherical with a stem, flat with a wide base. Polyps can be single or multiple. The average size of the formation is 1-2 cm.

Based on statistical data, polyposis more often affects men after 40 years of age. A fifth of the population suffers from growths in the sigmoid colon. The large intestine, its left part, including the sigmoid region, suffers more often. Detection of growths in right side intestines - less likely. Polyps in small intestine– a rarity.

A polyp is a benign growth. The danger is that some species transform into a malignant growth. The villous subtype of the adenomatous type of polyps has a tendency to malignancy.

Three types of polyps are diagnosed in the sigmoid colon:

• The hyperplastic appearance is characterized by a diameter of half a centimeter. The formation is similar to round, light-colored plaques. This species is not dangerous because it does not turn into a malignant tumor. The development of the disease should be monitored by a doctor.
• A dangerous growth that gradually develops into cancer is called the adenomatous type. These polyps are divided into 3 subtypes: villous, tubular, mixed. At first, development is asymptomatic. It can reach impressive sizes that block the intestinal lumen, leading to obstruction. The villous subspecies is characterized by a red color, with splashing blood vessels, upon mechanical action of which bleeding occurs. Blood in the stool is a sign of a bleeding adenomatous polyp.
• Diffuse polyps are a consequence of hereditary diseases. This type is observed in adults, elderly, and young people. The type is characterized by small multiple growths, numbering in the hundreds. People with Lynch, Turko, and Cowden syndrome are at risk.

Symptoms

The listed types of polyps in the first stages have scanty symptoms. For this reason, it is difficult to diagnose the disease. The formation is found by chance during an examination for another reason. Symptoms begin to appear with multiple polyposis, a single growth exceeding three centimeters in size.

• Sharp pain in the lower abdomen is the first clinical symptom, manifested by sudden movement or flexion of the abdomen.
• Stool with blood clots. The cause of this phenomenon is a bleeding villous polyp. Severe ulceration of the polyp leads to significant blood loss.
• A large amount of mucus is released with feces, which covers the glandular polyps.
• False urge to defecate, alternating diarrhea with constipation - the cause is the release of fluid from growths located in the sigmoid section of the large intestine.
• Loss of formations that have reached large sizes from the rectum.
• Flatulence, bloating, accompanied by heartburn, belching.
• Polyposis in the later stages is manifested by general weakness, fatigue, headache and increased body temperature of the patient.

Causes

Neoplasm in the sigmoid colon is due to several reasons. There is no clear reason for the appearance of growths. The formation of polyps is influenced by some factors, the unambiguousness of which has not been proven.

• The cause of growths in the sigmoid region is an unbalanced diet. Eating large amounts of fatty, sweet, and meat foods leads to an increase in carcinogens in human body. An insufficient amount of plant fiber in the body leads to a decrease in the level of intestinal motility. Stagnation resulting from decreased intestinal activity results in increased exposure of the intestinal lining to fecal carcinogens.
• A low level of human activity leads to periodic constipation and obesity, which leads to a decrease in the level of activity of intestinal peristalsis.
• The influence of genetic predisposition.
• Chronic intestinal disease (UC, Crohn's disease, diverticulosis).

Diagnosis

Polypoid formation of the sigmoid colon is rarely diagnosed in the first stages. Growths that do not manifest symptoms are never detected. diagnosed randomly. Diagnosis consists of a physical examination of the patient and diagnostics using instruments.

The first thing to start with the examination is a conversation with the patient. The patient talks about symptoms, previous illnesses, and nutrition. The doctor will also ask about any history of intestinal diseases in your immediate family. After the conversation, the doctor palpates the lower rectum for growths.

Diagnostics using special tools:

1. Colonoscopy. A colonoscope examination helps detect tumors in the sigmoid and examine the colon. A thin and flexible metal tube allows for a complete examination - right to the cecum. The colonoscope is inserted through the anus. To improve visibility, the intestine is straightened using air flow. If a growth is detected, a biopsy is taken. Small benign growths are removed immediately.
2. Sigmoidoscopy. Inspection with a sigmoidoscope is possible in the rectum and part of the sigmoid colon. The device has a camera and biopsy forceps.
3. Sigmoidoscopy. The sigmoidoscope is gentle compared to the colonoscope. The examination allows you to make an accurate diagnosis. The limitations of the sigmoidoscope are that it cannot detect polyps with a diameter of 1 cm.
4. Irrigoscopy. The point of the study is to introduce barium sulfate into the human colon. A contrast agent allows you to take x-rays that allow you to see tumors.

Treatment

Surgery to remove growths is the only effective way. Treatment with medications and folk ways are not effective.

Surgical intervention

Polypectomy is a method that involves removing a polyp using an instrument with a loop electrode. After the bleeding stops, the site of the former growth is cauterized. This method is suitable for formations of any size.

Next method– transanal excision. The growths are removed by inserting a rectal speculum, a clamp or a scalpel. The site of formation is sutured.

The endoscopic method is carried out using a rectoscope. The formations are removed no higher than 20 cm from the anus.

Resection is carried out in the worst case, with multiple ulcerated growths. Part of the sigmoid colon is removed, and an anastomosis is placed between the healthy edges of the section.

If the department finds cancerous tumors, the sigmoid colon is removed, after which a colostomy is formed. This method is called radical removal.

Diet after surgery

After the operation, the patient will have to change his diet. Reduce portions, but increase the number of meals to five. It is worth doing so that gastric juice is not produced; for this, one should not allow feelings of hunger. Eat food at least every 3 hours. Food is not hotter than 40 degrees, not colder than 20.

Eating more protein and whole milk will help stabilize and strengthen immune system person. It is recommended to eat meat-based soups, vegetable decoction. Eat vegetables in the form of puree, include dairy products in your diet. Fresh bread exclude, give preference to yesterday's or whole grain. Avoid sour berries, fruits, and those with hard skins. Add to diet boiled eggs soft-boiled