Liu Daren, Chen Li
Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Street, Hangzhou 310009, PR China.
Hepatogastroenterology. 2009 Nov-Dec;56(96):1679-82.
The management of diverticulosis in normal conditions is well established, but in certain situations such as the large and small bowel diverticulosis coexists in the same person and throughout the intestine, which is rarely seen, the management is still controversial, varying from an expectant approach to bulk bowel resection, which can be therapeutically challenging for surgeons. It was reported here a typical case of an 50-year-old woman diagnosed with total bowel diverticulosis including ileum, duodenum and colon for 6 years, admitted in emergency because of the perforations of the diverticula. And we discussed the management of the rare cases like this. The defined perforated sections, along with the entire distal colon including the sigmoid colon were removed on surgery. In our experience, asymptomatic patients in this situation are usually treated expectantly, with surgery reserved for acute complications. On the surgery, the distal margin of resection must be located in rectum instead of sigmoid and primary anastomosis is recommended if possible.
正常情况下憩室病的管理方法已得到充分确立,但在某些情况下,如同一人整个肠道中同时存在大肠和小肠憩室病,这种情况很少见,其管理仍存在争议,从观察等待到大规模肠切除不等,这对外科医生来说在治疗上具有挑战性。本文报道了一例典型病例,一名50岁女性被诊断为全肠道憩室病,累及回肠、十二指肠和结肠达6年,因憩室穿孔而急诊入院。我们讨论了此类罕见病例的处理方法。手术中切除了明确的穿孔部位以及包括乙状结肠在内的整个远端结肠。根据我们的经验,这种情况下无症状的患者通常采用观察等待的治疗方法,手术仅用于治疗急性并发症。在手术中,切除的远端边缘必须位于直肠而非乙状结肠,并且如果可能的话建议进行一期吻合。