Glaser Jeffrey, Farrell Michael Steven, Caplan Richard, Rubino Matthew
Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
Surgery, Christiana Care Health System, Wilmington, Delaware, USA.
Trauma Surg Acute Care Open. 2022 Jul 6;7(1):e000925. doi: 10.1136/tsaco-2022-000925. eCollection 2022.
The prevalence of diverticulitis has steadily increased during the past century. One possible complication of large bowel diverticulitis (LBD) is the concurrent development of a small bowel obstruction (SBO). The literature regarding these joint diagnoses is primarily limited to small case series from the 1950s. Consequently, no official recommendations or recent literature exists to guide decision making.
This is a retrospective case-control study with 5:1 matching by demographics, comorbidities, and Hinchey classification of patients presenting with concomitant LBD and SBO and patients with LBD alone. The primary outcome assessed was the need for same admission surgical intervention.
Patients with concurrent LBD and SBO were more likely to require surgical intervention (OR 4.2, p<0.001) and more likely to receive an open operation than patients with only LBD (p<0.001). The length of stay (LOS) was longer for LBD with SBO (mean LOS +3.2 days, p=0.003).
Patients with concurrent LBD and SBO are more likely to fail non-operative management. Given this, along with their longer LOS and higher rate of open surgery, earlier surgical intervention may improve outcomes and reduce hospital LOS.
在过去的一个世纪里，憩室炎的患病率稳步上升。大肠憩室炎（LBD）的一种可能并发症是并发小肠梗阻（SBO）。关于这些联合诊断的文献主要限于20世纪50年代的小病例系列。因此，目前尚无官方建议或近期文献来指导决策。
这是一项回顾性病例对照研究，对同时患有LBD和SBO的患者以及仅患有LBD的患者，按人口统计学、合并症和欣奇分类进行5:1匹配。评估的主要结局是是否需要在同一住院期间进行手术干预。
与仅患有LBD的患者相比，同时患有LBD和SBO的患者更有可能需要手术干预（比值比4.2，p<0.001），且更有可能接受开放手术（p<0.001）。伴有SBO的LBD患者住院时间更长（平均住院时间多3.2天，p=0.003）。
同时患有LBD和SBO的患者非手术治疗失败的可能性更大。鉴于此，以及他们较长的住院时间和较高的开放手术率，早期手术干预可能会改善预后并缩短住院时间。
4级。
