Mariani P, Imoulouden A, Kabalan A S, Houry S, Huguier M
Service de Chirurgie digestive, Hôpital Tenon, Chine, Paris.
Chirurgie. 1996;121(5):330-3; discussion 333-4.
From 1984 to 1993, 200 patients (mean age 68 years) were hospitalized for complicated diverticulosis of the colon. Hospitalization was motivated in 81 patients for a programmed procedure (40%), by an acute complication requiring emergency surgery in 56 (29%) and by acute complication treated medically in 63 (31%). Among the 81 electively operated patients, one died post-operatively. For the 56 patients operated in an emergency situation, there were 8 post-operative deaths (14%). Six of the 8 deaths occurred in patients over 80 years. The natural history of colonic diverticulosis suggests that it would be logical to operate those patients with two episodes of sigmoiditis of those who have clinical manifestations (47 cases in our series). The other indication for planned surgery are colonic stenosis (17 cases), sequellae of abscesses (16 cases) and fistulae (11 cases). In patients with peritonitis and pelvi-peritonitis (35 cases) for whom exeresis is not a technical risk, it appears to be preferable to colostomy with drainage. Abscesses should be drained under ultrasonic or scan control. Finally, patients with massive haemorrhage should have an emergency angiography to guide the colectomy.
1984年至1993年期间，200例（平均年龄68岁）结肠憩室炎并发症患者住院治疗。住院原因中，81例（40%）是为了进行计划性手术，56例（29%）是因急性并发症需要急诊手术，63例（31%）是因急性并发症接受药物治疗。在81例择期手术患者中，1例术后死亡。在56例急诊手术患者中，有8例术后死亡（14%）。8例死亡中有6例发生在80岁以上患者。结肠憩室炎的自然病程表明，对于有两次乙状结肠炎发作或有临床表现的患者（本系列中有47例）进行手术是合理的。计划性手术的其他指征是结肠狭窄（17例）、脓肿后遗症（16例）和瘘管（11例）。对于腹膜炎和盆腔腹膜炎患者（35例），如果切除手术不存在技术风险，那么似乎比结肠造口引流术更可取。脓肿应在超声或扫描引导下进行引流。最后，大量出血的患者应进行急诊血管造影以指导结肠切除术。
