Roch P J, Friedrich T, Bönninghoff R, Dinter D, Rickert A
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikums Heidelberg, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
Radiologische Abteilung des St. Josefskrankenhaus Heidelberg, St. Josefskrankenhaus Heidelberg, Landhausstraße 25, 69115, Heidelberg, Deutschland.
Chirurg. 2017 Aug;88(8):682-686. doi: 10.1007/s00104-017-0412-5.
Giant diverticula are rare complications of diverticular disease. Current opinion regards operative therapy as the method of choice for the treatment of symptomatic giant diverticula; however, there is neither consensus about the technique nor about the necessary extent of resection. Based on a non-systematic review of the literature, an overview of giant diverticula in terms of epidemiology, pathology and classification is given. The current case is considered with respect to appropriate diagnostic procedures and possible therapeutic options.
An 80-year-old female patient presented to the emergency department with abdominal pain and dyspnea. A computed tomography scan showed a large gas-filled structure in the upper left abdomen adjacent to the left colon. A giant colonic diverticulum was suspected and laparoscopy was performed. Intraoperatively, the diagnosis of a giant colon diverticulum located at the splenic flexure was confirmed. An unremarkable diverticulosis only was found in the descending colon. The giant diverticulum was treated by an atypical colon wedge resection and the postoperative course was uneventful.
This case report describes a laparoscopic atypical colon wedge resection as treatment of a giant colon diverticulum. Only four laparoscopic bowel resections in terms of sigmoid resections or hemicolectomy with primary anastomosis have been reported. Minimally invasive surgery can be a valuable alternative to open procedures. In the current case a laparoscopic atypical colon wedge resection was safely performed. This option might be considered as an alternative to extended resections of giant diverticula. Localization of the giant diverticulum and the simultaneous existence of diverticular disease are the main criteria for the decision between the different operative approaches.
巨大憩室是憩室病的罕见并发症。目前的观点认为手术治疗是有症状的巨大憩室的首选治疗方法；然而，对于手术技术以及必要的切除范围尚无共识。基于对文献的非系统综述，本文对巨大憩室的流行病学、病理学和分类进行了概述。结合当前病例探讨了合适的诊断程序和可能的治疗选择。
一名80岁女性患者因腹痛和呼吸困难就诊于急诊科。计算机断层扫描显示左上腹靠近左结肠处有一个巨大的充气结构。怀疑为巨大结肠憩室并进行了腹腔镜检查。术中证实为位于脾曲的巨大结肠憩室。仅在降结肠发现了不明显的憩室病。通过非典型结肠楔形切除术治疗巨大憩室，术后病程顺利。
本病例报告描述了通过腹腔镜非典型结肠楔形切除术治疗巨大结肠憩室。仅报道了4例关于乙状结肠切除术或一期吻合的半结肠切除术的腹腔镜肠切除术。微创手术可以是开放手术的一种有价值的替代方法。在当前病例中，成功实施了腹腔镜非典型结肠楔形切除术。该方法可被视为巨大憩室扩大切除术的一种替代方案。巨大憩室的定位以及憩室病的同时存在是决定不同手术方式的主要标准。
