Cooper Laura E, Turlington Margaret S, Brown Rebecca F
Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland.
Clin Colon Rectal Surg. 2024 Oct 11;38(4):257-262. doi: 10.1055/s-0044-1791284. eCollection 2025 Jul.
Diverticulitis is a prevalent medical issue, particularly among elderly individuals in the Western world. Management is nuanced and is influenced by both disease presentation and patient factors, especially those that affect risk of septic and surgical complications. This paper reviews existing literature to explore the incidence, presentation, and management of diverticulitis in complex medical contexts-immunocompromised populations, specifically highlighting those undergoing chemotherapy, HIV/AIDS patients, transplant recipients, and individuals with autoimmune and connective tissue diseases. Not surprisingly, management of diverticulitis in these complex patient populations is associated with increased morbidity. However, even taking into consideration the risk of septic and surgical complications, more recent data and treatment recommendations suggest that both nonoperative and operative management strategies may be appropriate based on individual patient presentations, mirroring the treatment paradigm of immunocompetent patients. In addition, in discussing operative management of complex medical patients, immunosuppression alone should not be considered a contraindication to primary anastomosis. Overall, there are limited existing data on diverticulitis in immunocompromised populations and, especially, patients with autoimmune and connective tissue disorders. Further research is warranted to better understand the impact of these chronic diseases on diverticulitis severity and to best inform evidence-based practices in this complex clinical scenario.
憩室炎是一个普遍存在的医学问题，在西方世界的老年人中尤为常见。其管理较为复杂，受到疾病表现和患者因素的影响，特别是那些影响感染性和手术并发症风险的因素。本文回顾现有文献，探讨复杂医学背景下（免疫功能低下人群，特别强调接受化疗的患者、艾滋病毒/艾滋病患者、移植受者以及患有自身免疫性和结缔组织疾病的患者）憩室炎的发病率、表现及管理。不出所料，在这些复杂患者群体中，憩室炎的管理与发病率增加相关。然而，即使考虑到感染性和手术并发症的风险，最新数据和治疗建议表明，根据个体患者的表现，非手术和手术管理策略可能都是合适的，这与免疫功能正常患者的治疗模式相似。此外，在讨论复杂医学患者的手术管理时，不应仅将免疫抑制视为一期吻合术的禁忌证。总体而言，关于免疫功能低下人群，尤其是患有自身免疫性和结缔组织疾病患者的憩室炎现有数据有限。有必要进行进一步研究，以更好地了解这些慢性疾病对憩室炎严重程度的影响，并为这一复杂临床场景中的循证实践提供最佳依据。
