Bakopoulos A, Tsilimigras D I, Syriga M, Koliakos N, Ntomi V, Moris D, Bistarakis D, Schizas D
Third Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece.
Department of Surgery, Duke University Medical Center, Duke University , Durham, NC , USA.
Ann R Coll Surg Engl. 2018 Aug 16;100(8):e1-e3. doi: 10.1308/rcsann.2018.0130.
The transverse colon is a particularly rare site for a diverticulum to develop, with only few reports of solitary diverticula described in the literature. Among the reported complications, colocutaneous fistulas appear relatively infrequently. We describe the case of an 80-year-old woman with a solitary diverticulum of the transverse colon presenting as acute diverticulitis with abscess formation in the epigastric region. A fistulous tract was found between the inflamed colon and the skin. A wedge resection of the inflamed colon together with the fistula and the solitary diverticulum was performed followed by primary suturing of the healthy colonic tissue. Despite the sufficient treatment and thorough clearance of the area, the patient died ten days later from ventilator associated pneumonia. Although rare, in patients presenting with a subcutaneous abscess in the abdominal region, there should be a high level of suspicion for active intraperitoneal inflammation derived from complicated diverticular disease given the continuously elevated prevalence of the condition in Western societies. The decision regarding proper management of this clinical state should be based on thorough clinical examination and imaging.
横结肠是憩室形成极为罕见的部位，文献中仅有少数关于孤立性憩室的报道。在已报道的并发症中，结肠皮肤瘘相对少见。我们描述了一例80岁女性，其横结肠有一个孤立性憩室，表现为急性憩室炎并伴有上腹部脓肿形成。在发炎的结肠与皮肤之间发现了一个瘘管。对发炎的结肠连同瘘管和孤立性憩室进行了楔形切除，随后对健康的结肠组织进行了一期缝合。尽管进行了充分的治疗且对该区域进行了彻底清理，但患者在十天后死于呼吸机相关性肺炎。尽管罕见，但对于出现腹部皮下脓肿的患者，鉴于西方社会中这种疾病的患病率持续上升，应高度怀疑存在由复杂憩室病引起的活动性腹腔内炎症。关于这种临床状态的恰当管理的决策应基于全面的临床检查和影像学检查。
