Zullo Angelo
Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.
Ann Gastroenterol. 2018 Nov-Dec;31(6):747-749. doi: 10.20524/aog.2018.0315. Epub 2018 Sep 26.
The pathogenetic process of acute diverticulitis remains speculative. According to the most widely accepted theory, the mechanism involved is "traumatic" damage to the mucosa due to fecolith impaction, as occurs in large diverticula. However, not uncommonly, diverticulitis develops in young patients with only few and small diverticula, where fecolith trapping is very unlikely. Therefore, another theory is necessary to clarify this process. A possible explanation could be "ischemic" damage. According to this theory, an ischemic lesion is caused by the compression of vascular structures in the neck of the diverticular task, as a result of prolonged and/or recurrent contractile spikes related to neuromuscular alterations in the diverticular tract. Clearly, the "traumatic" and "ischemic" mechanisms of acute diverticulitis are not mutually exclusive, and may act in different patients. The existing data corroborating these theories are presented and different potential therapeutic approaches are briefly discussed.
急性憩室炎的发病机制仍存在推测性。根据最广泛接受的理论，所涉及的机制是由于粪石嵌塞对黏膜造成“创伤性”损伤，就像在大憩室中发生的那样。然而，憩室炎在仅有少量小憩室的年轻患者中并不罕见，而在这些患者中粪石嵌顿的可能性极小。因此，需要另一种理论来阐明这一过程。一种可能的解释可能是“缺血性”损伤。根据这一理论，憩室颈部血管结构受压导致缺血性病变，这是由于与憩室道神经肌肉改变相关的长期和/或反复收缩尖峰所致。显然，急性憩室炎的“创伤性”和“缺血性”机制并非相互排斥，可能在不同患者中起作用。本文介绍了支持这些理论的现有数据，并简要讨论了不同的潜在治疗方法。
