Division of Colorectal Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010-3000, United States.
World J Gastroenterol. 2021 Mar 7;27(9):760-781. doi: 10.3748/wjg.v27.i9.760.
Diverticular disease and diverticulitis are the most common non-cancerous pathology of the colon. It has traditionally been considered a disease of the elderly and associated with cultural and dietary habits. There has been a growing evolution in our understanding and the treatment guidelines for this disease. To provide an updated review of the epidemiology, pathogenesis, classification and highlight changes in the medical and surgical management of diverticulitis. Diverticulitis is increasingly being seen in young patients (< 50 years). Genetic contributions to diverticulitis may be larger than previously thought. Potential similarities and overlap with inflammatory bowel disease and irritable bowel syndrome exist. Computed tomography imaging represents the standard to classify the severity of diverticulitis. Modifications to the traditional Hinchey classification might serve to better delineate mild and intermediate forms as well as better classify chronic presentations of diverticulitis. Non-operative management is primarily based on antibiotics and supportive measures, but antibiotics may be omitted in mild cases. Interval colonoscopy remains advisable after an acute attack, particularly after a complicated form. Acute surgery is needed for the most severe as well as refractory cases, whereas elective resections are individualized and should be considered for chronic, smoldering, or recurrent forms and respective complications (stricture, fistula, etc) and for patients with factors highly predictive of recurrent attacks. Diverticulitis is no longer a disease of the elderly. Our evolving understanding of diverticulitis as a clinical entity has led into a more nuanced approach in both the medical and surgical management of this common disease. Non-surgical management remains the appropriate treatment for greater than 70% of patients. In individuals with non-relenting, persistent, or recurrent symptoms and those with complicated disease and sequelae, a segmental colectomy remains the most effective surgical treatment in the acute, chronic, or elective-prophylactic setting.
憩室病和憩室炎是结肠最常见的非癌性病变。它传统上被认为是老年人的疾病，与文化和饮食习惯有关。我们对这种疾病的认识和治疗指南一直在不断发展。提供憩室炎的流行病学、发病机制、分类的最新综述，并强调其在医学和外科治疗方面的变化。憩室炎在年轻患者（<50 岁）中越来越常见。遗传因素对憩室炎的贡献可能比以前认为的更大。与炎症性肠病和肠易激综合征存在潜在的相似性和重叠。计算机断层扫描成像代表了分类憩室炎严重程度的标准。对传统的 Hinchey 分类的修改可能有助于更好地区分轻度和中度形式，并更好地分类慢性憩室炎的表现。非手术治疗主要基于抗生素和支持性措施，但在轻度病例中可以省略抗生素。急性发作后，特别是在复杂形式后，仍建议进行间隔结肠镜检查。对于最严重和难治性病例需要进行急性手术，而择期切除术是个体化的，对于慢性、潜伏性或复发性形式以及各自的并发症（狭窄、瘘管等）以及具有高度预测反复发作的因素的患者应考虑。憩室炎不再是老年人的疾病。我们对憩室炎作为一种临床实体的不断发展的认识，导致了在这种常见疾病的医学和外科管理方面采用了更加细致入微的方法。非手术治疗仍然是超过 70%的患者的适当治疗方法。对于持续存在、持续存在或反复发作的症状的患者，以及患有复杂疾病和后遗症的患者，在急性、慢性或预防性情况下，节段性结肠切除术仍然是最有效的手术治疗方法。
