1Department of General Surgery, St John of God Midland Hospital, Midland, Western Australia, Australia.
2School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.
Surg Infect (Larchmt). 2019 Sep;20(6):499-503. doi: 10.1089/sur.2019.070. Epub 2019 May 8.
Jejunal diverticulitis is rare and usually an incidental diagnosis found on imaging. Its symptoms are non-specific. Hence, the diagnosis often is delayed, and a high mortality rate has been reported. The aim of this study was to review our experience in the management of jejunal diverticulitis and to propose a management algorithm. A retrospective review of all cases of jejunal diverticulitis seen from November 2015 to November 2018 was performed. Data collected included demographics, history of diverticulitis, risk factors, clinical presentation, biochemistry and imaging results, and management outcome. Eight patients were identified during the study period, five females and three males with a median age of 71 years (range 61-85 years). One patient was on steroid treatment, and one patient had a history of jejunal diverticulitis. Abdominal pain was present in all patients, but other symptoms were variable. Two patients were initially believed to have constipation and were discharged home. All patients underwent a computed tomography (CT) scan for the diagnosis, showing that three had uncomplicated jejunal diverticulitis and five had localized perforation. Five patients were managed conservatively initially; two failed this treatment because of small bowel obstruction and persistent abdominal pain with rising inflammatory markers. Three underwent emergency laparotomy (two because of sepsis; one was thought to have a foreign body). There were no deaths. A proposed management algorithm is discussed. A CT scan is the mainstay for the accurate diagnosis of jejunal diverticulitis. The proposed algorithm can aid in selection of patients suitable for conservative management.
空肠憩室炎罕见，通常在影像学检查中偶然发现。其症状无特异性。因此，诊断常常延迟，且已有报告称其死亡率较高。本研究旨在回顾我们在空肠憩室炎治疗方面的经验，并提出一种治疗方案。
对 2015 年 11 月至 2018 年 11 月间所有空肠憩室炎患者的病例进行回顾性分析。收集的数据包括人口统计学、憩室炎病史、危险因素、临床表现、生化和影像学结果以及治疗结果。
研究期间共确诊 8 例患者，均为女性 5 例，男性 3 例，中位年龄 71 岁（61-85 岁）。1 例患者正在接受类固醇治疗，1 例患者有过空肠憩室炎病史。所有患者均有腹痛，但其他症状各不相同。2 例患者最初被误诊为便秘并出院回家。所有患者均接受了计算机断层扫描（CT）检查以确诊，结果显示 3 例为单纯性空肠憩室炎，5 例有空肠局部穿孔。5 例患者最初接受保守治疗；2 例因小肠梗阻和持续性腹痛伴炎症标志物升高而治疗失败。3 例患者接受了紧急剖腹手术（2 例因脓毒症；1 例被认为有异物）。无死亡病例。讨论了一种拟议的治疗方案。CT 扫描是准确诊断空肠憩室炎的主要方法。所提出的算法有助于选择适合保守治疗的患者。
