PECULIARITIES OF DIAGNOSIS AND TREATMENT OF COLONIC ACUTE DIVERTICULITIS
Objectives. To study peculiarities of diagnosis and treatment outcomes of the colonic acute diverticulitis (AD) using contemporary methods. Methods. Fifty-eight patients with colonic acute diverticulitis have been observed. Clinical manifestations of the disease, diagnosis and treatment peculiarities have been studied. On the 1 st and 4 th days after hospitalization content of faecal calprotectin (FC), cytokines (tumor necrosis factor (TNF-α), interleukin-6 (IL-6) and interleukin-10 (IL-10)) have been determined in the blood serum using the method of quantitative immune enzyme test-system for analysis in accordance with the author’s instruction. To control the intoxication, the cell tests of reactivity and intoxication (CTRI) have been determined: leukocytic index according to Kalf-Kalif, Ostrovsky, Fischenko and Khymich, index of leukocyte correlation of Osin, nuclear index of intoxication of Dashtayants. The results of treatment have been analyzed. Results. During the acute period of the disease the non-invasive methods of diagnosis (US, CT), X-ray and endoscopic methods were considered to be preferable after reduction of acute symptoms. Content of FC, TNF-α, IL-6, IL-10 and ratio TNF-α/IL-10 statistically reliable different from analogue indices of the control group and tended to normalization during the second examination, correlated with CTRI. Conservative treatment was effective in 81% of patients; operative interventions have been used in 11 cases. 5 resections of the sigmoid colon and 4 left-side hemicolectomies with the application of anastomoses have been carried out; in 2 cases transverse colostomy has been applied after laparotomy. Conclusion. The diagnosis of acute diverticulitis can usually be made on the basis of the study of clinical symptoms and results of non-invasive (ultrasound, X-ray, biochemical, laboratory) methods of research. At the same time indices of faecal calprotectin, pro- and anti-inflammatory cytokines of the blood significantly vary as well as their ratio, which is thought to be a marker of the disease. In 19% of cases acute diverticulitis requires the operative treatment with preference to carry out resection of the affected parts of colon with the application of anastomoses.