Basili Giancarlo, Celona Giuseppe, Lorenzetti Luca, Angrisano Claudio, Biondi Graziano, Preziuso Enrico, Dal Canto Massimiliano, Goletti Orlando
UO Chirurgia Generale, Az USL 5 PISA, PO Pontedera, Pisa.
Chir Ital. 2006 Jan-Feb;58(1):55-9.
Right-sided diverticulitis is difficult to distinguish from other sources of right-sided abdominal pain and, in particular, is frequently indistinguishable from acute appendicitis preoperatively. Because of the problems concerning preoperative diagnosis and controversies in the management, the choice of the best therapy on the surgeon's part is still open. A total of 1150 patients with a clinical diagnosis of right acute abdomen observed in our surgical department from 1995 to 2003 was analysed. Three patients had a pathologically confirmed diagnosis of caecal diverticulitis. The mean age of the patients was 37 years. Right lower quadrant pain and local tenderness were the only clinical findings in 95.3% of the cases, with a preoperative diagnosis of acute appendicitis in 2 of 3 patients. The operative findings were an inflammatory mass in the caecum and the presence of a minimal amount of free peritoneal fluid. Two patients underwent laparoscopic ileocecectomy and one had a diverticulectomy. The postoperative course was uneventful. Because of the difficulties in diagnosis and surgical treatment, caecal diverticulitis has been the subject of much discussion in the literature and many questions remain unanswered. Right-sided diverticulitis is easily confused with acute appendicitis because it occurs at a somewhat younger age than sigmoid diverticulitis. Caecal diverticulitis needs a high index of suspicion for achieving a preoperative diagnosis. Diverticulectomy should be performed in patients with small diverticula with a limited inflammatory reaction. Right colectomy should be performed in patients with perforation of the diverticulum, caecal phlegmon or abscess formation. A correct intraoperative diagnosis is therefore crucial for selection of the surgical procedure. Laparoscopic treatment of a solitary, acutely infected colon diverticulum is feasible in this setting. A minimally invasive procedure could be performed, therefore, in patients with right acute abdomen, allowing not only the right diagnosis but also the treatment of the commonest pathologies responsible for this clinical picture.
右侧憩室炎很难与其他引起右侧腹痛的病因相鉴别，尤其是在术前，它常常难以与急性阑尾炎区分开来。由于术前诊断存在问题以及治疗方面的争议，外科医生对于最佳治疗方法的选择仍未确定。对1995年至2003年在我们外科就诊的1150例临床诊断为右侧急腹症的患者进行了分析。其中3例经病理确诊为盲肠憩室炎。患者的平均年龄为37岁。95.3%的病例中，右下腹痛和局部压痛是仅有的临床表现，3例患者中有2例术前诊断为急性阑尾炎。手术所见为盲肠有炎性包块以及少量游离腹腔积液。2例行腹腔镜回盲部切除术，1例行憩室切除术。术后恢复顺利。由于诊断和手术治疗存在困难，盲肠憩室炎一直是文献中讨论的热点，许多问题仍未得到解答。右侧憩室炎容易与急性阑尾炎混淆，因为它的发病年龄比乙状结肠憩室炎稍小。要实现术前诊断，对盲肠憩室炎需要高度怀疑。对于炎症反应局限的小憩室患者应行憩室切除术。对于憩室穿孔、盲肠蜂窝织炎或脓肿形成的患者应行右半结肠切除术。因此，正确的术中诊断对于选择手术方式至关重要。在这种情况下，腹腔镜治疗孤立的、急性感染的结肠憩室是可行的。因此，对于右侧急腹症患者可以采用微创手术，不仅可以做出正确诊断，还能治疗导致这种临床表现的最常见疾病。
