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 Printable version |
Management of colonic diverticular disease infectious complications |
Hépato-Gastro. Volume 19, Number 6, 419-25, Juin 2012, Mini-revue
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 Résumé
Texte intégral
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Author(s) : Richard Douard, Philippe Wind |
Summary : Diverticular disease is due to the low fiber diet in developed countries. This is a public health issue since the frequency of diverticular disease increases with age and reached a frequency of more than 60% at the age of 80 years in the general population. Diverticular disease affects the sigmoid colon in 90% of cases. Infectious complications are the most frequent with various presentations from the uncomplicated diverticulitis to faecal peritonitis. Curative treatment of uncomplicated diverticulitis is based on antibiotic treatment. The treatment of complicated diverticulitis may involve medical treatment ± associated to a radiological drainage or to emergency surgery especially in cases of peritonitis. The laparoscopic approach has been recently developed to treat non-faecal peritonitis in immunocompetent patients. The real place of this new technique remains to be defined. The Hartmann procedure is the procedure of choice in the fecal peritonitis and when conditions are not favourable. A better understanding of the history of the disease has led to question the indications for prophylactic surgery after several bouts of diverticulitis. Indeed, complicated diverticulitis are inaugural, diverticulitis recurrence have a low frequency and a low mortality, which is comparable to that of prophylactic surgery. Transplant patients, immunocompromised patients or patients who need treatments that increase the risk of perforation (NSAID, steroids...) may be proposed for prophylactic sigmoid resection even if the benefit of this approach has not been demonstrated. Elective surgery for diverticular disease is now intented to treat complications (fistula, symptomatic stenosis), persistent diagnostic doubt with colon cancer) or for rare patients having recurrent and disabling bouts of diverticulitis. Laparoscopy is the preferred surgical approach in elective sigmoidectomies. |
Keywords : colon diverticular disease, diverticulitis, peritonitis, sigmoidectomy, treatment, laparoscopic peritoneal lavage |
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