Akut Divertikülit
Özet
Akut divertikülit, kolonik divertiküllerin inflamasyonuyla karakterize, acil servislerde sık karşılaşılan bir akut karın nedenidir. Prevalansı yaşla birlikte artan bu hastalık, mikroperforasyon ve lokal inflamatuvar yanıt mekanizmasıyla gelişmektedir. Tanı sürecinde klinik değerlendirme ve laboratuvar bulguları önemli olsa da intravenöz kontrastlı bilgisayarlı tomografi altın standart görüntüleme yöntemi olarak kabul edilir. Hastalığın yönetimi, Hinchey sınıflamasına göre belirlenen klinik şiddete ve komplikasyon varlığına göre şekillenir. Güncel yaklaşımlar, komplike olmayan vakalarda rutin antibiyotik kullanımını sorgulamakta ve seçilmiş hastalarda gözlemsel tedaviyi desteklemektedir. Komplike olgularda ise hastaneye yatış, intravenöz antibiyoterapi ve gerektiğinde cerrahi veya girişimsel müdahaleler esastır.
Acute diverticulitis is a common cause of acute abdominal pain in emergency departments, characterized by the inflammation of colonic diverticula. Its prevalence increases with age, and the underlying pathophysiology involves microperforation leading to a local inflammatory response. While clinical evaluation and laboratory tests are integral to the diagnostic process, intravenous contrast-enhanced computed tomography remains the gold standard imaging modality. Management strategies are guided by clinical severity and the presence of complications, typically categorized using the Hinchey classification. Current guidelines suggest a shift away from routine antibiotic use in uncomplicated cases, favoring observational treatment for selected patients. Conversely, complicated cases necessitate hospitalization, intravenous antibiotics, and, when indicated, surgical or interventional procedures.
Referanslar
Sartelli M, Weber DG, Kluger Y, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World Journal of Emergency Surgery. 2020;15:32.
Strate LL, Morris AM. Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology. 2019;156(5):1282–1298.
Andeweg CS, Mulder IM, Felt-Bersma RJF, et al. Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Digestive Surgery. 2013;30(4–6):278–292.
Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Advances in Surgery. 1978;12:85–109.
Ambrosetti P, Becker C, Terrier F. Colonic diverticulitis: impact of imaging on surgical management—a prospective study of 542 patients. European Radiology. 2002;12(5):1145–1149.
Chabok A, Påhlman L, Hjern F, Haapaniemi S, Smedh K; AVOD Study Group. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. British Journal of Surgery. 2012;99(4):532–539.
Daniels L, Ünlü C, de Korte N, et al. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. British Journal of Surgery. 2017;104(1):52–61.
Graham A. Acute Diverticulitis. In: Tintinalli JE, Ma OJ, Yealy DM, Meckler GD, Stapczynski JS, Cline DM, Thomas SH, editors. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York: McGraw-Hill Education; 2020. Chapter 82.
Feuerstein JD, Falchuk KR. Diverticulosis and diverticulitis. The New England Journal of Medicine. 2016;374(6):558–568.
Referanslar
Sartelli M, Weber DG, Kluger Y, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World Journal of Emergency Surgery. 2020;15:32.
Strate LL, Morris AM. Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology. 2019;156(5):1282–1298.
Andeweg CS, Mulder IM, Felt-Bersma RJF, et al. Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Digestive Surgery. 2013;30(4–6):278–292.
Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Advances in Surgery. 1978;12:85–109.
Ambrosetti P, Becker C, Terrier F. Colonic diverticulitis: impact of imaging on surgical management—a prospective study of 542 patients. European Radiology. 2002;12(5):1145–1149.
Chabok A, Påhlman L, Hjern F, Haapaniemi S, Smedh K; AVOD Study Group. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. British Journal of Surgery. 2012;99(4):532–539.
Daniels L, Ünlü C, de Korte N, et al. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. British Journal of Surgery. 2017;104(1):52–61.
Graham A. Acute Diverticulitis. In: Tintinalli JE, Ma OJ, Yealy DM, Meckler GD, Stapczynski JS, Cline DM, Thomas SH, editors. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York: McGraw-Hill Education; 2020. Chapter 82.
Feuerstein JD, Falchuk KR. Diverticulosis and diverticulitis. The New England Journal of Medicine. 2016;374(6):558–568.
