Schaffzin David M, Wong W Douglas
Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
Clin Colon Rectal Surg. 2004 Aug;17(3):169-76. doi: 10.1055/s-2004-832698.
The complications of diverticular disease of the colon can be divided into those related to inflammatory conditions (diverticular abscess, fistula, and perforation) and those related to noninflammatory conditions (lower gastrointestinal hemorrhage and noninflammatory stricture or obstruction). Nonoperative management of uncomplicated diverticulitis includes bowel rest and antibiotics. For abscesses, percutaneous drainage by radiologic guidance often turns complicated diverticulitis to an uncomplicated condition. In very select instances, fistulas or even perforation may be managed without operation. Strictures may be dilated or stented. Diverticular hemorrhage may be controlled with colonoscopic and angiographic techniques. For colonoscopy, these include cautery, epinephrine injection, and endoclips. For angiography, these include arterial infusion of vasopressin and selective embolization of bleeding vessels. For both diverticulitis and diverticular bleeding, these nonoperative therapeutic modalities may be utilized as a bridge to surgery, or in select instances as a definitive therapy obviating the need for surgery.
结肠憩室病的并发症可分为与炎症性疾病相关的并发症（憩室脓肿、瘘管和穿孔）以及与非炎症性疾病相关的并发症（下消化道出血和非炎症性狭窄或梗阻）。非复杂性憩室炎的非手术治疗包括肠道休息和使用抗生素。对于脓肿，在放射学引导下进行经皮引流通常可将复杂性憩室炎转变为非复杂性情况。在极少数特定情况下，瘘管甚至穿孔也可无需手术进行处理。狭窄可通过扩张或置入支架治疗。憩室出血可通过结肠镜和血管造影技术控制。对于结肠镜检查，这些技术包括烧灼、肾上腺素注射和内镜夹闭。对于血管造影，这些技术包括动脉内注入血管加压素和对出血血管进行选择性栓塞。对于憩室炎和憩室出血，这些非手术治疗方式既可用作手术的桥梁，也可在某些特定情况下作为避免手术需求的确定性治疗方法。
