Durgakeri Pramod, Strauss Paul
Department of Surgery, Central Gippsland Health Service, Sale, VIC, Australia.
Australas Med J. 2015 Mar 31;8(3):85-8. doi: 10.4066/AMJ.2015.2279. eCollection 2015.
Sigmoid colon diverticulosis is commonly seen in both the surgical outpatient and emergency departments. Rarely, these sigmoid diverticulum, which usually range from 2-3mm to 2cm in size, can enlarge to more than 10 times. This is due to a ball-valve type mechanism that traps colonic gas inside the sigmoid diverticulum causing it to gradually enlarge. Patients with a giant sigmoid diverticulum (GSD) must be investigated thoroughly as two per cent of patients will present with a colonic carcinoma either within or distal to the GSD. Clinical symptoms of a GSD can range from chronic abdominal pain, altered bowel habits, abdominal distention, weight loss, bleeding, perforation, fistula formation, or bowel obstruction. CT and plain abdominal x-ray is the investigation of choice for its diagnosis. Barium enema is useful to determine the presence of a carcinoma within the GSD. Sigmoidoscopy is useful to rule out a distal colonic carcinoma. This is the first published case where nocturnal diarrhoea is the primary differentiating symptom in the patient. The treatment of choice for a GSD is complete resection of the diverticulum and/or the adjacent sigmoid colon. This can be performed with a primary anastomosis or a double-stage procedure.
乙状结肠憩室病在外科门诊和急诊科都很常见。很少见的是，这些通常大小在2 - 3毫米至2厘米之间的乙状结肠憩室会增大到超过原来的10倍。这是由于一种球阀机制，将结肠气体困在乙状结肠憩室内，导致其逐渐增大。患有巨大乙状结肠憩室（GSD）的患者必须进行全面检查，因为2%的患者会在GSD内或其远端出现结肠癌。GSD的临床症状包括慢性腹痛、排便习惯改变、腹胀、体重减轻、出血、穿孔、瘘管形成或肠梗阻。CT和腹部平片是诊断该病的首选检查方法。钡剂灌肠有助于确定GSD内是否存在癌。乙状结肠镜检查有助于排除远端结肠癌。这是首次发表的以夜间腹泻为患者主要鉴别症状的病例。GSD的首选治疗方法是完整切除憩室和/或相邻的乙状结肠。这可以通过一期吻合术或两阶段手术来完成。
