Ambrosetti Patrick
Department of Surgery, Clinique Générale Beaulieu, Geneva, Switzerland.
Clin Exp Gastroenterol. 2016 Aug 18;9:249-57. doi: 10.2147/CEG.S110428. eCollection 2016.
The diagnostic approach of patients with suspected acute diverticulitis remains debated. On the one hand, a scoring system with the best predictive value in diagnosing acute diverticulitis has been developed in order to reduce the use of computed tomography (CT) scan, while, on the other hand, patients with a high probability of acute diverticulitis should benefit from CT scan from a clinical viewpoint, ensuring that they will receive the most appropriate treatment. The place and classification of CT scan for acute diverticulitis need to be reassessed. If the management of uncomplicated acute diverticulitis, abscess, and fecal peritonitis is now well codified, urgent surgical or medical treatment of hemodynamically stable patients presenting with intraperitoneal air or fluid without uncontrolled sepsis is still under discussion. Furthermore, the indications for laparoscopic lavage are not yet well established. It is known for years that episode(s) of acute uncomplicated diverticulitis may induce painful recurrent bowel symptoms, known as symptomatic uncomplicated diverticular disease and irritable bowel syndrome-like diverticular disease. These two clinical expressions of diverticular disease, that may darken quality of life, are treated medically aimed at symptom relief. The possible place of surgery should be discussed. Clinical and CT scan classifications should be separated entities.
疑似急性憩室炎患者的诊断方法仍存在争议。一方面，为了减少计算机断层扫描（CT）的使用，已经开发出一种在诊断急性憩室炎方面具有最佳预测价值的评分系统；另一方面，从临床角度来看，急性憩室炎可能性高的患者应受益于CT扫描，以确保他们能接受最合适的治疗。急性憩室炎CT扫描的地位和分类需要重新评估。如果说目前对于单纯性急性憩室炎、脓肿和粪性腹膜炎的处理已有明确规范，那么对于血流动力学稳定、存在腹腔内气体或液体且无失控性脓毒症的患者，其紧急手术或内科治疗仍在讨论之中。此外，腹腔镜灌洗的适应证尚未明确确立。多年来已知，单纯性急性憩室炎发作可能诱发疼痛性反复肠道症状，即所谓的症状性单纯性憩室病和肠易激综合征样憩室病。这两种憩室病的临床表现可能会影响生活质量，通常采用药物治疗以缓解症状。对于手术可能发挥的作用应进行讨论。临床分类和CT扫描分类应区分开来。
