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Posted by Specialist II Phan Thanh Nguyen - General Surgery - General Surgery Department - Vinmec Central Park International General Hospital
Colonic diverticulum is a common disease, especially after the age of 40. When colonic diverticulum is inflamed but not diagnosed and treated in time, it can leave serious complications, easy to confuse with colorectal cancer. Should I have surgery for diverticulitis?
1. Diverticulitis of the colon
Colonic diverticula are pouch-like structures that develop in the colon wall formed by the mucosa and submucosa that penetrate the wall of the colon. Diverticulosis is common in the sigmoid colon and left colon, but it can also involve the entire colon.
The risk of colonic diverticulosis in the US: 5% of the population in their 40s, to 80% of the population at the age of 80. Of which, 10-20% of people with colonic diverticulitis will develop diverticulitis. and in this group there will be 10-20% hospitalized for treatment. In the group hospitalized for treatment, the rate of surgery accounted for 20-50%.
Viêm túi thừa đại tràng có thể tử vong nếu không chữa kịp thời.
2. When is surgery indicated for diverticulitis?
Patients with colonic diverticulitis will be admitted to the hospital with left iliac fossa pain, fever and leukocytosis. However, sometimes abdominal pain in the right half of the abdomen if diverticulitis is in the right colon (common in Vietnam and Southeast Asian countries).
On the computed tomography (CT) scan of the abdomen, the colon shows thickening of the wall, fatty infiltrates or paracolon, mass, abscess, intestinal narrowing or fistula formation. If the patient is stable on medical treatment through an acute episode of diverticulitis, colonoscopy will be indicated after 6-8 weeks to confirm the diagnosis of colonic diverticulitis.
For the group of patients who are evaluated for diverticulitis without perforation on CT scan of the abdomen, they will be treated with oral or intravenous antibiotics and will be considered for subsequent colectomy with diverticulitis if necessary. set. According to the recommendations of the American Society of Colon and Rectal Surgeons (ASCRS), the decision to recommend a colectomy for patients with persistent colitis is not Evidence should be individualized, depending on risk factors for surgery, health status, quality of life (repeated pain affecting work, people often travel...), cancer cannot be ruled out. colon cancer or persistent disease,... However, this recommendation does not apply to patients under 50 years of age, organ transplant recipients or immunocompromised patients.
Chụp CT chp phép chẩn đoán bệnh viêm túi thừa đại tràng
For the group of patients when undergoing abdominal CT scan to evaluate diverticulitis with complications of perforation, whether or not immediate surgery is indicated should be based on Hinchey's stage classification or Fleishmann's grading scale for colonic diverticulum. (2011) as follows: Table 1. Grading system for diverticulitis with perforated diverticulum on abdominal CT:
| Phân độ | Định nghĩa |
| 1 | Hơi tự do khu trú cạnh đại tràng, không có áp-xe. |
| 2 | Khoảng hơi tự do cạnh đại tràng nhỏ (< 2cm) HOẶC áp xe nhỏ ( < 4 cm). |
| 3 | Khoảng hơi tự do cạnh đại tràng lớn (> 2cm) HOẶC áp xe lớn ( > 4 cm). |
| 4 | Nhiều hơi và dịch tự do trong khoang phúc mạc (Viêm phúc mạc do phân) |
Also according to the ASCRS recommendation, patients with perforated diverticulum with unstable vital signs need immediate surgery. If the patient has a perforated colonic diverticulum, but the condition is stable, it should be managed according to the following flow chart:
Tables 2 and 3. Management flowcharts Colitis diverticulitis has complications of diverticulitis.
Bảng 2
Bảng 3
Diverticulitis is a common digestive disease. Today, the treatment of diverticulitis is mainly medical treatment. However, in case of diverticulitis with complications of perforation, it is necessary to comprehensively evaluate the patient and appoint surgery or drain the abscess at the right time, in order to ensure that the patient is safe and the most effective treatment. . Therefore, for patients with symptoms of suspected diverticulitis, they need to be examined and treated at a medical facility with adequate equipment for diagnosis and should be examined by a specialist surgeon. Digest.
Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in examination and surgery of digestive diseases, patients completely You can rest assured that you will be examined and treated at the Hospital.
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References :American Society of Colon and Rectal Surgeons : Practice parameters for sigmoid diverticulitis.
Fleischmann et al , Disease of colon and rectum 2011:54:663-671.
