Sigmoiditis

SIGMOIDITIS (sigmoiditis), a disease comprising various pathological inflammatory processes in the S-shaped colon. In some cases, these processes are merely a partial manifestation of inflammation of the entire large intestine—colitis, while in others they are a segmental form, often extending to the rectum, and then one speaks of proctosigmoiditis. The sigmoid colon is particularly predisposed to inflammatory processes because physiologically its contents stagnate relatively long for the formation of fecal masses. Etiologically, pressure on this segment of the intestine by neighboring organs (pregnant uterus), changes in the shape and position of the intestine itself (sigma elongatum), adhesions remaining from previous inflammatory processes, and venous stagnation, infectious diseases, especially local ones (dysentery), but also general ones (septic anginas, influenza, malaria, etc.); finally, the most frequently occurring diverticula in this segment of the intestine, as well as functionally-originated protrusions of the large intestine, recently described by radiologists (N. Berg) under the name of diverticulosis, causing stagnation on one hand, and inflammation (diverticulitis) on the other. By course, acute and chronic inflammation of the S-shaped colon are distinguished; by character and localization of the inflammatory process, catarrhal or mucous sigmoiditis 10ИДИТ 40& (sigmoiditis mucosa, levis)—a milder form, and purulent-hemorrhagic—a more severe form, most often proceeding with tissue disintegration in the form of an ulcerative process (sigmoiditis suppurativa, exulcerans, gravis), and finally a third form—perisigmoiditis, when the process extends to the serous membrane of the intestine and forms an infiltrate in the paracolon, producing paracolitis or mesosigmoiditis (see Mesentery, Retroperitoneal Space, Paracolitis). Naturally, these various anatomical processes can combine with each other and provide the substrate for very diverse clinical manifestations of S., sometimes very difficult to recognize. Acute S. of the catarrhal type was first described by Mayor; in 1893 he gave a clinical picture resembling perityphlitis, but with localization in the left iliac region and easily confused with appendicitis with a medial position of the appendix. Sharp pains appear in the left iliac region, radiating to the lower back and left leg, nausea, vomiting, constipation with tenesmus, feverish condition. Objectively: meteorism, tenderness in the region of the 11. sigmoideae, as well as on the left upon examination through the rectum, the intestine is thickened, filled with fecal masses. Purulent and hemorrhagic forms of S. most often proceed as subacute and chronic diseases. However, if acute S. is accompanied by proctitis—proctosigmoiditis,—stools consist only of bloody mucus without feces (see Stools); conversely, with a longer course of the process, persistent diarrhea with bloody, meaty-purge colored stools, liquid, foul-smelling, appear. Very often, signs of perisigmoiditis are added (see below). The disease usually proceeds favorably if no complications appear from the pericolic tissue. Thrombophlebitis of the lower left limb has been described as a result of sigmoiditis. However, in the acute form described, S. occurs relatively infrequently.—TREATMENT—rest with mandatory bed rest, ice on the abdomen in the first days, alcohol compresses, hot water bottles, fomentations after the temperature drops and after acute phenomena disappear. Nutrition—liquid and mushy food, lots of butter, enemas of Provence or other vegetable oil or liquid paraffin. From medications—pantopon, atropine.

Chronic S. develops from acute or arises directly as a chronic disease. Here all transitions from mucous, catarrhal forms to purulent-hemorrhagic are observed. Patients usually complain of irregular defecation, more often of diarrhea than of constipation; tenesmus with the discharge of mucous or bloody-purulent stools containing a significant number of erythrocytes, leukocytes, pus cells, epithelium, and sometimes eosinophilic cells should be considered characteristic of chronic S. Patients also complain of unpleasant sensations in the left iliac region, general weakness, emaciation. Upon examination of the patient, the fl. sigmoidea is determined in the form of a cylinder, usually filled with fecal masses, sensitive to palpation, however, well mobile. Examination with the finger per anum gives no deviations in pure forms of S. Diagnosis can be easily established by rectoscopy, which gives various pictures, starting with marked reddening of the mucosa, usually not diffuse, but focal; in other cases, along with reddening, superficial excoriations and erosions of the mucosa can be found, sometimes bleeding; finally, in more severe cases, there are true ulcers. Sometimes the intestines are covered with overgrowths at this time, and a picture resembling trachoma of the eye is obtained. In far-advanced cases, the intestinal wall is infiltrated, loses its elasticity, which to a large extent complicates endoscopic examination. In addition to endoscopy, the recognition of S. is facilitated by X-ray examination using the 'relief' technique of the mucosa, which easily reveals not only organic changes, diverticulitis, ulcers_g but also functional disorders in the area of fl. sigmoideae, especially spastic conditions of the intestine. Differential diagnosis of S. must consider other intestinal diseases, especially its neoplasms, diseases of the left renal pelvis and ureters, diseases of the appendages in women. If the inflammatory process extends beyond the serous membrane, then S. is complicated by perisigmoiditis. Depending on the nature of the exudate, it is either an infiltrate of varying density, sometimes encircling the entire fl. sigmoidea, or tumor-like formations giving reason to think of malignant neoplasm, gumma, or limited tuberculous peritonitis. In addition to painful sensations with intestinal distension, during movements and physical exertion, these infiltrates can also cause symptoms of partial intestinal obstruction.—Chronic S. and perisigmoiditis have very different courses, most often periods of remission appear, followed by exacerbation under the influence of dietary violations, trauma, and physical exertions, colds and infections (influenza, angina).—TREATMENT of chronic S. requires prescribing a diet with fiber restriction, i.e., a diet that gives little slag but contains enough carbohydrates in the form of porridge, pasta, puddings, then egg dishes, minced meat and especially lots of fats—butter and Provence oil. From medications, bismuth preparations, tanalbin are given. The use of tannin enemas is not recommended, warm enemas from chamomile decoction or vegetable oil, introduced under slight pressure on the balloon with a long and soft tip, work much better. Atropine and papaverine are indicated to reduce spasm and regulate defecation, which the patient must constantly take care of when constipation appears. Treatment with mineral waters (Essentuki, Zheleznovodsk) brings certain benefit. Great benefit can be obtained, especially with perisigmoiditis and chronic forms of S, from systematically conducted mud therapy. In individual cases, diathermy is beneficial. In severe cases of ulcerative S. with exhausting purulent-bloody stools (sigmoiditis gravis), repeated blood transfusions must be applied, this can save the patient from heavy surgical intervention with the creation of an artificial anal fistula.