Thorisson A, Nikberg M, Andreasson K, Smedh K, Chabok A
a Department of Radiology , Västmanlands Hospital Västerås , Sweden.
c Centre for Clinical Research Uppsala University, Västmanlands Hospital Västerås , Sweden.
Scand J Gastroenterol. 2018 Oct-Nov;53(10-11):1298-1303. doi: 10.1080/00365521.2018.1520291. Epub 2018 Oct 24.
The aim of this study was to describe patient characteristics and results of non-operative management for patients presenting with computed tomography (CT) verified perforated diverticulitis with extraluminal or free air.
All patients treated for diverticulitis (ICD-10: K-57) during 2010-2014 were identified and medical records were reviewed. Re-evaluations of CT examinations for all patients with complicated disease according to medical records were performed. All patients diagnosed with perforated diverticulitis and extraluminal or free air on re-evaluation were included and characteristics of patients having immediate surgery and those whom non-operative management was attempted are described.
Of 141 patients with perforated diverticulitis according to medical records, 136 were confirmed on CT re-evaluation. Emergency surgical intervention within 24 h of admission was performed in 29 (21%) patients. Non-operative management with iv antibiotics was attempted for 107 patients and was successful in 101 (94%). The 30-day mortality rate was 2%. The presence of a simultaneous abscess was higher for patients with failure of non-operative management compared with those that were successfully managed non-operatively (67% compared to 17%, p = .013). Eleven out of thirty-two patients (34%) with free air were successfully managed conservatively. Patients that were operated within 24 h from admission were more commonly on immunosuppressive therapy, had more commonly free intraperitoneal air and free fluid in the peritoneal cavity.
Non-operative management is successful in the majority of patients with CT-verified perforated diverticulitis with extraluminal air, and also in one-third of those with free air in the peritoneal cavity.
本研究旨在描述经计算机断层扫描（CT）证实患有伴有腔外或游离气体的穿孔性憩室炎患者的特征及非手术治疗结果。
确定2010年至2014年期间所有接受憩室炎治疗（国际疾病分类第十版：K-57）的患者，并查阅病历。根据病历对所有患有复杂疾病的患者进行CT检查重新评估。纳入所有在重新评估时被诊断为穿孔性憩室炎且伴有腔外或游离气体的患者，并描述立即进行手术的患者以及尝试非手术治疗的患者的特征。
根据病历，141例患有穿孔性憩室炎的患者中，136例经CT重新评估得到证实。29例（21%）患者在入院24小时内接受了紧急手术干预。对107例患者尝试了静脉使用抗生素的非手术治疗，其中101例（94%）成功。30天死亡率为2%。与非手术治疗成功的患者相比，非手术治疗失败的患者同时存在脓肿的情况更多（分别为67%和17%，p = 0.013）。32例有游离气体的患者中有11例（34%）保守治疗成功。入院后24小时内接受手术的患者更常接受免疫抑制治疗，腹腔内更常出现游离气体和游离液体。
对于大多数经CT证实伴有腔外气体的穿孔性憩室炎患者，以及三分之一腹腔内有游离气体的患者，非手术治疗是成功的。
