Roth J L
Postgrad Med. 1976 Dec;60(6):85-90. doi: 10.1080/00325481.1976.11708407.
A patient over 40 years of age who complains of lower abdominal pain, constipation or diarrhea or both, and increased flatulence should be suspected of having diverticulosis. When pain becomes more severe and persistent, diverticulitis must be considered. Diagnosis depends on roentgen demonstration of the presence of diverticula. Sigmoidoscopy and barium enema study are essential to exclude coexisting disease but in diverticulitis may need to be postponed until severe local and systemic signs of inflammation have subsided. A number of diseases can simulate diverticulitis, and differential diagnosis may present considerable difficulty. Irritable colon syndrome and acute appendicitis may be indistinguishable clinically from diverticulitis. Differentiation from carcinoma is usually not difficult, but exclusion of coexistent carcinoma may be impossible except by resection. Ulcerative colitis is also easily distinguished except when, rarely, it coexists. Crohn's disease of the colon is less easily differentiated, especially in patients over 40, in whom the two diseases often coexist. Other colonic diseases, such as ischemic colitis, and pelvic inflammatory diseases usually show characteristic features which make them readily distinguishable from diverticulitis.
40岁以上的患者，若主诉下腹部疼痛、便秘或腹泻或两者兼有，且肠胃胀气加剧，则应怀疑患有憩室病。当疼痛变得更加严重且持续时，必须考虑憩室炎。诊断取决于X线显示憩室的存在。乙状结肠镜检查和钡灌肠研究对于排除并存疾病至关重要，但在憩室炎时，可能需要推迟到严重的局部和全身炎症体征消退后进行。许多疾病可能类似憩室炎，鉴别诊断可能会有相当大的困难。肠易激综合征和急性阑尾炎在临床上可能与憩室炎难以区分。与癌的鉴别通常不难，但除非通过切除，否则可能无法排除并存的癌。溃疡性结肠炎也很容易区分，除非很少见的情况下它与之并存。结肠克罗恩病较难鉴别，尤其是在40岁以上的患者中，这两种疾病常并存。其他结肠疾病，如缺血性结肠炎和盆腔炎，通常表现出特征性表现，使其易于与憩室炎区分开来。
