Vayre P
Service de Chirurgie Générale et Digestive, Groupe Hospitalier Pitié-Salpêtrière, Paris.
J Chir (Paris). 1990 Nov;127(11):547-51.
Diverticular disease is generally benign but may be life threatening should progressive complications occur. Under these circumstances cure may only be obtained if properly performed surgery is undertaken at the right moment. The end result of a low fibre diet, diverticular disease may affect the entire colon, but always tends to particularly affect the sigmoid region. This is the usual site of complications where the etiology is related to diverticular infection associated with fecal impaction proximal to the high pressure zone at the recto-sigmoid junction. The radical treatment of sigmoid diverticulitis is rectosigmoid resection, however, this concept may be altered according to the circumstances as follows: 1 - sigmoid diverticulitis without pericolic complications 2 - peri-sigmoid complications: peri-sigmoid abscess, intestinal and vesical fistulae. 3 - generalised peritonitis due to perforation into the peritoneal cavity. The advanced age of the patient should be stressed (mean age 65 years and 25% over 75 years) associated with a high incidence of multiple organ failure and hence the high mortality in more than 50% of cases in the event of peritonitis.
憩室病通常为良性，但如果出现进行性并发症则可能危及生命。在这种情况下，只有在恰当的时机进行恰当的手术才能治愈。低纤维饮食的最终结果，憩室病可能影响整个结肠，但总是特别倾向于影响乙状结肠区域。这是并发症的常见部位，其病因与直肠乙状结肠交界处高压区近端的粪便嵌塞相关的憩室感染有关。乙状结肠憩室炎的根治性治疗是直肠乙状结肠切除术，然而，这一概念可能会根据以下情况而改变：1 - 无结肠周围并发症的乙状结肠憩室炎；2 - 乙状结肠周围并发症：乙状结肠周围脓肿、肠瘘和膀胱瘘；3 - 因穿孔进入腹腔导致的弥漫性腹膜炎。应强调患者的高龄（平均年龄65岁，25%超过75岁），这与多器官功能衰竭的高发生率相关，因此在发生腹膜炎的情况下，超过50%的病例死亡率很高。
