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Panminerva Medica 2001 December;43(4):289-93

lingua: Inglese

New perspectives in the management of sigmoid diverticulitis

Petrakis I., Sakellaris G., Kogerakis N., Zacharioudakis G., Kourtis D., Xynos E., Chalkiadakis G.

From the Department of General Surgery University Hospital of Herakleion University Medical School of Herakleion University of Crete, Crete, Greece


The sig­moid ­colon is the ­part of the ­large intes­tine, ­which ­most com­mon­ly ­involved in diver­tic­u­lar dis­ease due to its ana­tom­i­cal prop­er­ties. Diverticular dis­ease of the ­colon is ­being ­seen ­with increas­ing fre­quen­cy most­ly in west­ern coun­tries. Diverticulitis ­results ­from inflam­ma­tion and sub­se­quent per­fo­ra­tion of a colon­ic diver­tic­u­lum. Mild ­forms of diver­tic­u­litis usu­al­ly ­present ­with grad­u­al­ly increas­ing symp­toms ­from the low­er ­left quad­rant of the abdo­men, where­as ­acute com­pli­cat­ed dis­ease is char­ac­ter­ised by dra­mat­ic ­onset of abdom­i­nal ­pain, fol­lowed by ­fever with­in a few ­hours. The stan­dard treat­ment for uncom­pli­cat­ed diver­tic­u­litis is bow­el ­rest, ­with liq­uid ­diet or intra­ve­nous ­fluids in com­bi­na­tion ­with anti­bi­o­tics. Prophylactic resec­tion is not to be rec­om­mend­ed for ­patients ­with diver­tic­u­lar dis­ease, but a ­high-­fibre ­diet may ­afford pro­tec­tion by pre­vent­ing fur­ther com­pli­ca­tions. Patients not respond­ing to con­ser­va­tive treat­ment with­in the ­first 24 ­hours ­require fur­ther eval­u­a­tion by com­put­ed tomog­ra­phy or ultra­so­nog­ra­phy. Fistula for­ma­tion and intes­ti­nal obstruc­tion are indi­ca­tions for sur­gi­cal inter­ven­tion, ­although the fre­quent recur­rent ­attacks, ­which com­mon­ly ­afflict ­these ­patients, are sel­dom asso­ciat­ed ­with ­severe com­pli­ca­tions. Laparoscopic ­approach has ­been intro­duced in the diag­no­sis and defin­i­tive treat­ment of uncom­pli­cat­ed diver­tic­u­litis, ­with ­less mor­bid­ity and mor­tal­ity ­rates, and hos­pi­tal­isa­tion of the ­patients and in ­these ­terms ­could be prom­is­ing in the ­future.

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