Stagnitti F, Salvi P F, Schillaci F, Priore F, Corona F, Tiberi R, De Pascalis M
Università degli Studi La Sapienza di Roma, Istituto Dipartimentalizzato di Clinica d'Urgenza e Pronto Soccorso.
G Chir. 2005 Mar;26(3):89-93.
Diverticulitis of the right colon is a rare disease in the Western countries, so that the diagnosis still remains very difficult and frequently indistinguishable from acute appendicitis preoperatively. In presence of acute abdominal discomfort with pain referred to the right lower quadrant region, fever and hyperleukocytosis, nausea and vomiting, surgeons operate with a margin of uncertainty, because of the increased morbidity and mortality associated with delay in diagnosis and consequent perforation of acute appendicitis. Moreover the unexpected inflammatory colonic mass of uncertain etiology is sometimes mistaken for carcinoma at laparotomy and consequently a right hemicolectomy is performed. In these cases it should be better that right-sided colonic diverticulitis should be taken into account allowing a more correct surgical approach and even conservative treatment alone. Therefore, in case of suspected appendicitis, since our experience and literature data indicate that the mean age for right diverticulitis is over 40 years, also in presence of a significative Alvarado's score, computed tomography is strongly recommended, if the age is over 40 years.
右半结肠憩室炎在西方国家是一种罕见疾病，以至于术前诊断仍然非常困难，且常常难以与急性阑尾炎区分开来。当出现急性腹部不适、疼痛放射至右下腹区域、发热、白细胞增多、恶心和呕吐时，由于急性阑尾炎诊断延迟及随之而来的穿孔会增加发病率和死亡率，外科医生手术时会存在一定的不确定性。此外，病因不明的意外炎性结肠肿块有时在剖腹手术时被误诊为癌，从而进行了右半结肠切除术。在这些情况下，最好考虑到右侧结肠憩室炎，以便采取更正确的手术方法，甚至仅采用保守治疗。因此，在怀疑为阑尾炎的情况下，由于我们的经验和文献数据表明右半结肠憩室炎的平均年龄超过40岁，所以即使阿尔瓦拉多评分有意义，如果年龄超过40岁，强烈建议进行计算机断层扫描。
