McKee R F, Deignan R W, Krukowski Z H
Department of Surgery, Aberdeen Royal Infirmary, Foresterhill, UK.
Br J Surg. 1993 May;80(5):560-5. doi: 10.1002/bjs.1800800506.
Optimal management of acute sigmoid diverticulitis depends on evaluation of the severity of the inflammatory process, in which radiological investigation is a useful but probably underutilized adjunct to clinical assessment. Plain abdominal radiography shows abnormalities in 30-50 per cent of patients but these tend to be non-specific and more accurate information is obtainable from a contrast enema. Although the quality of images produced by a water-soluble contrast agent is inferior to that with barium, the former is less hazardous in the presence of perforation and provides sufficient information to permit rational management decisions to be made. Ultrasonography and computed tomography (CT) are particularly useful in visualizing abscesses. They may be helpful in following the progression or resolution of suppuration and in guiding percutaneous aspiration when appropriate. Despite early reports to the contrary, CT is no more specific than a contrast enema in the diagnosis of acute diverticulitis. Radionuclide scans have little role in the routine assessment of acute diverticulitis and magnetic resonance imaging has not been adequately evaluated. Water-soluble contrast enema is safe, widely available and probably the most useful early supplementary investigation.
急性乙状结肠憩室炎的最佳治疗取决于对炎症过程严重程度的评估，其中放射学检查是临床评估中一种有用但可能未得到充分利用的辅助手段。腹部平片在30%至50%的患者中显示异常，但这些异常往往不具有特异性，而从钡剂灌肠造影可获得更准确的信息。尽管水溶性造影剂产生的图像质量不如钡剂，但在存在穿孔的情况下，前者危害较小，并能提供足够信息以做出合理的治疗决策。超声检查和计算机断层扫描（CT）在显示脓肿方面特别有用。它们可能有助于观察化脓过程的进展或消退，并在适当的时候指导经皮穿刺抽吸。尽管早期有相反的报道，但CT在急性憩室炎的诊断中并不比钡剂灌肠造影更具特异性。放射性核素扫描在急性憩室炎的常规评估中作用不大，而磁共振成像尚未得到充分评估。水溶性钡剂灌肠造影安全、广泛可用，可能是最有用的早期辅助检查。
