Nahrwold D L, Demuth W E
Ann Surg. 1977 Jan;185(1):80-3. doi: 10.1097/00000658-197701000-00013.
Sigmoid diverticulitis with free perforation or perforation through the mesentery results in generalized peritonitis. Emergency surgical treatment is mandatory, but the most efficacious procedure has not been clearly established. Ten consecutive patients were treated by removal of the perforated sigmoid colon, temporary end colostomy and peritoneal toilet. All but one patient survived the initial procedure, and there were only four minor complications. The preoperative diagnosis was correct in 8 of the 10 patients. Analysis of the preoperative clinical findings revealed that a decision in favor of immediate operation was not difficult. The predominant clinical manifestations were severe abdominal pain and tenderness, fever, and elevation of the white blood cell count. The most reliable diagnostic finding was localization of the area of maximum tenderness to the left lower quadrant and suprapubic areas. While it is not applicable for all the pathologic manifestations of diverticulitis, sigmoid colectomy, temporary end colostomy and peritoneal toilet is efficacious therapy in perforative diverticulitis with free communication between the colonic lumen and the peritoneal cavity.
伴有游离穿孔或经肠系膜穿孔的乙状结肠憩室炎可导致弥漫性腹膜炎。急诊手术治疗是必要的，但最有效的手术方式尚未明确确立。连续10例患者接受了穿孔乙状结肠切除、临时性末端结肠造口术及腹腔灌洗治疗。除1例患者外，其余患者均在初次手术后存活，仅出现4例轻微并发症。10例患者中有8例术前诊断正确。对术前临床表现的分析表明，做出立即手术的决定并不困难。主要临床表现为严重腹痛、压痛、发热及白细胞计数升高。最可靠的诊断依据是最大压痛区位于左下腹和耻骨上区域。虽然乙状结肠切除术、临时性末端结肠造口术及腹腔灌洗并不适用于憩室炎的所有病理表现，但对于结肠腔与腹腔之间存在自由交通的穿孔性憩室炎而言，却是有效的治疗方法。
