Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
Department of Emergency Medicine, UCSF Fresno, Fresno, CA, USA.
Am J Emerg Med. 2024 Feb;76:1-6. doi: 10.1016/j.ajem.2023.10.051. Epub 2023 Nov 5.
Acute diverticulitis is a condition commonly seen in the emergency department (ED). Therefore, it is important for emergency medicine clinicians to be aware of the current evidence regarding the diagnosis and management of this disease.
This paper evaluates key evidence-based updates concerning acute diverticulitis for the emergency clinician.
Diverticulitis is a complication of diverticulosis and most commonly affects the sigmoid and descending colon in Western countries. History and examination can suggest the diagnosis, with abdominal pain and tenderness in the left lower quadrant being the most common symptom and sign, respectively. Change in bowel habits and fever may also occur. Laboratory testing may demonstrate leukocytosis or an elevated C-reactive protein. Imaging options can include computed tomography (CT) of the abdomen and pelvis with intravenous contrast, magnetic resonance imaging (MRI), or ultrasound (US), though most classification systems for diverticulitis incorporate CT findings. While the majority of diverticulitis cases are uncomplicated, complications may affect up to 25% of patients. Treatment of complicated diverticulitis requires antibiotics and surgical consultation. Antibiotics are not required in select patients with uncomplicated diverticulitis. Appropriate patients for supportive care without antibiotics should be well-appearing, have pain adequately controlled, be able to tolerate oral intake, be able to follow up, have no complications, and have no immunocompromise or severe comorbidities.
An understanding of literature updates can improve the ED care of patients with acute diverticulitis.
急性憩室炎是急诊科常见的病症。因此，对于急诊医学临床医生来说，了解该疾病的当前诊断和管理证据非常重要。
本文评估了有关急性憩室炎的关键循证更新，以帮助急诊临床医生。
憩室炎是憩室病的并发症，在西方国家最常影响乙状结肠和降结肠。病史和体格检查可提示诊断，左下腹疼痛和压痛是最常见的症状和体征。排便习惯改变和发热也可能发生。实验室检查可能显示白细胞增多或 C 反应蛋白升高。影像学检查可包括腹部和骨盆的 CT 增强扫描、磁共振成像（MRI）或超声（US），但大多数憩室炎分类系统都包含 CT 结果。虽然大多数憩室炎病例是单纯性的，但并发症可能影响多达 25%的患者。复杂性憩室炎的治疗需要使用抗生素和手术咨询。在选择的单纯性憩室炎患者中不需要使用抗生素。不需要使用抗生素的适当患者应表现良好，疼痛得到充分控制，能够耐受口服摄入，能够随访，没有并发症，没有免疫抑制或严重合并症。
了解文献更新可以改善急诊科急性憩室炎患者的治疗。
