University of North Carolina School of Medicine, Chapel Hill, NC 27599-7555, USA
BMJ. 2021 Mar 24;372:n72. doi: 10.1136/bmj.n72.
Left sided colonic diverticulitis is a common and costly gastrointestinal disease in Western countries, characterized by acute onset of often severe abdominal pain. Imaging is necessary to make an initial diagnosis and determine disease severity. Colonoscopy should be done six to eight weeks after diagnosis to rule out a missed colon malignancy. Antibiotic treatment is used selectively in immunocompetent patients with mild acute uncomplicated diverticulitis. The clinical course of diverticulitis commonly includes unpredictable recurrences and chronic gastrointestinal symptoms, which are a detriment to quality of life. A better understanding of prognosis has prompted a shift toward non-operative approaches. The decision to undergo prophylactic colon resection should be individualized to consider the severity of diverticulitis, the patient's health and immune status, and the patient's preferences and values, as well as benefits and risks. Because only a section of colon is removed, recurrent diverticulitis remains a risk. Acute diverticulitis with an abscess is treated with antibiotics that cover Gram negative and anaerobic bacteria, with or without percutaneous drainage. Acute diverticulitis with purulent or feculent contamination of the peritoneal cavity is managed with surgery; primary resection and anastomosis is the procedure of choice in stable patients.
左侧结肠憩室炎是西方国家一种常见且代价高昂的胃肠道疾病，其特征为急性发作、常伴有严重腹痛。影像学检查对于初步诊断和确定疾病严重程度是必要的。诊断后 6-8 周应进行结肠镜检查，以排除漏诊的结肠癌。对于免疫功能正常、患有轻度急性单纯性憩室炎的患者，选择性使用抗生素治疗。憩室炎的临床病程通常包括不可预测的复发和慢性胃肠道症状，这会降低生活质量。对预后的更好理解促使人们转向非手术治疗方法。预防性结肠切除术的决定应个体化，要考虑憩室炎的严重程度、患者的健康和免疫状况、患者的偏好和价值观，以及获益和风险。因为仅切除一部分结肠，所以憩室炎仍有复发的风险。伴有脓肿的急性憩室炎采用覆盖革兰氏阴性和厌氧菌的抗生素治疗，可联合或不联合经皮引流。伴有脓性或粪性污染的急性憩室炎采用手术治疗；对于稳定的患者，首选一期切除吻合术。
