Harbi Houssem, Kardoun Nizar, Fendri Sami, Dammak Nouha, Toumi Nozha, Guirat Ahmed, Mzali Rafik
Habib Bourguiba Hospital, Department of General Surgery, 3029 Sfax, Tunisia.
Habib Bourguiba Hospital, Department of General Surgery, 3029 Sfax, Tunisia.
Presse Med. 2017 Dec;46(12 Pt 1):1139-1143. doi: 10.1016/j.lpm.2017.08.009. Epub 2017 Nov 11.
Diverticulitis is much less common in the jejunum than in colonic diverticula probably because of diverticulum larger size, better intra-luminal flow and relatively sterile jejunal content. Complications of jejunal diverticulitis are acute intestinal obstruction, diverticular bleeding and mainly perforation with mesenteric abscess, localized or generalized peritonitis. The Multi-detector row computed tomography is now the best diagnostic imaging for small bowel diverticulitis as well as its complications. Magnetic resonance enterography is also quite useful but it is still impractical to resort to such an imaging in an abdominal emergency. Non-surgical treatment is usually sufficient for jejunal diverticulitis without peritonitis but it does not prevent recurrence of diverticulitis. Surgery is mandatory in case of generalized peritonitis or voluminous local abscess complicating small bowel diverticulitis. In case of extensive small bowel diverticulosis, resection should be limited to the intestinal loop with complicated diverticulum (local abscess, peritonitis or bleeding) to avoid short bowel syndrome. Poor prognostic factors are advanced age, associated comorbidities, delayed diagnosis and mainly the time interval between perforation and surgery.
空肠憩室炎比结肠憩室少见得多，这可能是因为空肠憩室较大、肠腔内血流较好且空肠内容物相对无菌。空肠憩室炎的并发症包括急性肠梗阻、憩室出血，主要是伴有肠系膜脓肿、局限性或弥漫性腹膜炎的穿孔。多层螺旋计算机断层扫描现在是小肠憩室炎及其并发症的最佳诊断成像方法。磁共振小肠造影也很有用，但在腹部急诊时采用这种成像方法仍然不切实际。对于无腹膜炎的空肠憩室炎，非手术治疗通常就足够了，但它不能预防憩室炎复发。如果小肠憩室炎并发弥漫性腹膜炎或大量局部脓肿，则必须进行手术。对于广泛的小肠憩室病，切除应限于伴有复杂憩室（局部脓肿、腹膜炎或出血）的肠袢，以避免短肠综合征。预后不良的因素包括高龄、合并症、诊断延迟，主要是穿孔与手术之间的时间间隔。
