Toda Susumu, Ito Yasuhiko, Mizuno Masashi, Suzuki Yasuhiro, Ito Isao, Hiramatsu Hideki, Ozaki Takenori, Tsuboi Naotake, Sato Waichi, Maruyama Shoichi, Imai Enyu, Matsuo Seiichi
Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nephrol Dial Transplant. 2012 Jun;27(6):2511-6. doi: 10.1093/ndt/gfr685. Epub 2011 Dec 20.
Colonic diverticulitis is an important cause of polymicrobial peritonitis, which requires surgical treatment and cessation of peritoneal dialysis (PD). The aim of this study was to examine whether plain abdominal computed tomography (CT) is useful for evaluating colonic diverticulosis in chronic kidney disease (CKD) patients and to explore whether colonic diverticulosis is a risk factor for enteric peritonitis.
The subjects consisted of 137 consecutive CKD patients (Stage 4 or 5) who were candidates for PD from February 2005 to November 2009. Abdominal CT without contrast media was performed in all PD candidates.
Diverticula of the colon were detected by plain CT in 57 cases (41.6%). The number of diverticula tended to increase with age. The most common site of involvement of diverticulosis was the ascending colon. In patients treated with PD, the incidence of peritonitis was higher in patients with diverticulosis than in those without diverticulosis (P = 0.004). However, only one episode of enteric peritonitis was observed among patients with diverticulosis. The presence of diverticulosis did not affect cumulative or technical survival. PD was not selected in four cases due to a high frequency of diverticula with episodes of abdominal pain. Two cases developed severe diverticulitis with peritonitis and underwent resection of the colon.
Our study suggests that plain CT examination is useful for detecting diverticulosis in CKD patients. Silent diverticulosis is not a risk factor for enteric diverticulosis-related peritonitis. PD may be contraindicated in cases having frequent diverticulosis with episodes of lower abdominal pain.
结肠憩室炎是引起多种微生物性腹膜炎的重要原因，这种情况需要进行手术治疗并停止腹膜透析（PD）。本研究的目的是检查腹部平扫计算机断层扫描（CT）是否有助于评估慢性肾脏病（CKD）患者的结肠憩室病，并探讨结肠憩室病是否是肠道腹膜炎的危险因素。
研究对象为2005年2月至2009年11月连续入选的137例CKD患者（4期或5期），均为PD治疗候选者。所有PD候选者均接受了无对比剂的腹部CT检查。
57例（41.6%）患者通过腹部平扫CT检测到结肠憩室。憩室数量有随年龄增加的趋势。憩室病最常见的受累部位是升结肠。在接受PD治疗的患者中，有憩室病的患者腹膜炎发生率高于无憩室病的患者（P = 0.004）。然而，在有憩室病患者中仅观察到1例肠道腹膜炎。憩室病的存在不影响累积生存率或技术生存率。4例患者因憩室频繁发作伴腹痛而未选择PD治疗。2例患者发生严重憩室炎伴腹膜炎并接受了结肠切除术。
我们的研究表明，腹部平扫CT检查有助于检测CKD患者的憩室病。无症状憩室病不是肠道憩室病相关腹膜炎的危险因素。对于憩室频繁发作伴下腹痛的患者，PD治疗可能是禁忌的。
