Hinchey E J, Schaal P G, Richards G K
Adv Surg. 1978;12:85-109.
Diverticular disease of the colon now is recognized to be functional disease resulting from altered neuromuscular activity in the colon. Inflammatory complications, when they occur, usually result from inflammation around a single diverticulum. This may lead to the formation of a pericolic or pelvic abscess. Free perforation of these leads to purulent peritonitis. The original communication with the lumen of the bowel usually is obliterated. More rarely, with either rapid evolution or failure of the diverticular neck to obliterate, a free communication develops between the bowel lumen and the peritoneal cavity, leading to fecal peritonitis. Fecal peritonitis results in an extremely high mortality rate. The operative approach for a patient with perforated diverticular disease should be individualized and depends on the stage of the disease present, the general condition of the patient, the experience of the surgeon in colon surgery and the availability of facilities and personnel to provide intensive care. In larger institutions when these conditions are optimal, primary resection of the diseased bowel with or without anastomosis is becoming the procedure of choice. In smaller institutions or if conditions are not optimal, right transverse colostomy with drainage of the perforated segment can be relied on to control the disease with a mortality rate compared to that of primary resection. If free perforation and fecal peritonitis are present, exteriorization or primary resection of the perforated segment must be carried out. We would not recommend primary anastomosis under these circumstances.
结肠憩室病现在被认为是一种由于结肠神经肌肉活动改变而导致的功能性疾病。炎症并发症一旦发生，通常是由单个憩室周围的炎症引起的。这可能会导致结肠周围或盆腔脓肿的形成。这些脓肿的自由穿孔会导致脓性腹膜炎。与肠腔的原始通道通常会闭塞。更罕见的情况是，要么病情快速发展，要么憩室颈部未能闭塞，肠腔与腹膜腔之间会形成自由通道，导致粪性腹膜炎。粪性腹膜炎的死亡率极高。对于穿孔性憩室病患者的手术方法应个体化，这取决于疾病所处的阶段、患者的一般状况、外科医生在结肠手术方面的经验以及提供重症监护的设施和人员的可用性。在较大的机构中，当这些条件最佳时，对患病肠段进行一期切除（无论是否进行吻合）正成为首选的手术方式。在较小的机构中，或者如果条件不理想，可以依靠右半横结肠造口术并对穿孔段进行引流来控制病情，其死亡率与一期切除相比有所不同。如果存在自由穿孔和粪性腹膜炎，则必须对穿孔段进行外置或一期切除。在这些情况下，我们不建议进行一期吻合。
